Queen Aesthetics Medical Spa & Online Training

BY SIMONE HOPES, PA-C Queen The Aesthetic Injector

THE BEGINNERS GUIDE TO

AESTHETIC INJECTIONS Result Driven. Realistic. Relatable. Rejuvenating

MISSION & motto

MISSION

• To achieve realistic cosmetic results and decrease adverse events through proper training of cosmetic injectables to medical professionals. Queen Aesthetics looks to promote higher education and understanding of facial anatomy and injection techniques to achieve optimal results.

MOTTO

• Where everyone gets the Red Carpet treatment.

IMPORTANT information Upon completion of this training seminar, students will be able to accurately assess and treat patients with neurotoxins for cosmetic enhancements with safe injection techniques. Such techniques can be used in the treatment of glabellar lines, frown lines, crow’s feet, and bunny lines. Continued training and experience are recommended for practice success. Participants will receive a Course manual and Goodie bag in relation to injections, hands-on demonstrations, and a Certificate of Completion at the end of the course.

T his is not a c ertif y ing c ours e but an intro to inje c table s that w ill ultimately be the training ne e de d to potentially land a role in the c os metic bus ine s s or add to an ex is ting prac tic e . T his c ours e IS N O T intende d for me dic al treatment (migraine s , overac tive bladder, etc .) of s ome dis eas e s but s tric tly c os metic us e . T here are off label us e s that Q ue en A e sthetic s doe s not endors e and w ill not be demons trate d during this c ours e . T he s e methods are s olely of Q ue en A e sthetic s from prev ious training and ex perienc e and in c onjunc tion w ith a c onsulting inje c tion s erv ic e . Q ue en A e s thetic s or its c ounterparts are not liable .

QUEEN THE AESTHETIC INJECTOR

OVERVIEW

COURSE REQUIREMENTS:

• In the state of Texas, to take the course you have to be a licensed healthcare professional. This course is for physicians, Nurse Practitioners(NP), Physician Assistant (PA), Registered Nurse (RN), DDS, DDM, or Licensed Vocational Nurse (LVN).

• If there is no medical license to practice medicine and working under the direct supervision of a physician please contact Queen Aesthetics before registering for the course.

• Minimum age of 18 years old • Proficient in English

COURSE OBJECTIVES

A. Toxins • Understanding the history and safety of neuromodulators (Botox, Dysport, Jeuveau) • Cosmetic indications and contraindications • Mechanism of Action and efficacy • Dilution and storage • Anatomy and physiology as it applies to facial aesthetics • Aesthetic evaluation and consultation • Injection techniques and protocol • Risks and complications • Regulatory • Pricing, practice considerations, and marketing B. Kybella • Understanding submental and neck anatomy • Indications and contraindications • Evaluation and Consultation • Injection technique, risks, and complications • Pricing, practice considerations, and marketing

THE BEGINNERS GUIDE | 3

COURSE agenda

9:00 AM

10:45 AM

9:15 AM

11:00 AM

Introduction to Toxins

History of Neurotoxins

9:30 AM

Injection technique

Patient consultation, preparation & post-treatment

Handling, Reconstitution and Storage

11:15 AM

9:40 AM

12:00 PM

Review of facial muscle anatomy

10:10 AM

Patient selection

10:20 AM

Indications and contraindications

10:30 AM Break

Side effects & complications

Lunch provided with topic discussion: Building your Business

12:30 PM

All things Kybella

1:00 PM

Demo/hands-on training of neurotoxins and Kybella

4:30 PM

Q&A session & Conclusion with certificate distribution

CURRICULUM

INTRODUCTION

Toxins- Used to treat moderate to severe fine lines and wrinkles of the glabella, forehead, crow’s feet, bunny lines, gummy smiles, hyperhidrosis (axilla), TMJ. The formation of facial lines is a result of repeated muscle contractions from facial expressions (frowning, squinting, smiling, raising eyebrows) that can cause the skin to fold and furrow. These cosmetic injections work beneath the surface to temporarily reduce muscle activity by blocking nerve impulses to the treated muscles, causing them to relax thus reducing dynamic wrinkles and softening expressions. The key to understanding these intramuscular injections is that there are recommended dosages but everything will be tailored to the patient and that is where the art happens. Toxins should not be used in children, pregnant, or nursing women.

QUEEN THE AESTHETIC INJECTOR

HISTORY OF TOXINS

A. BOTOX (ALLERGAN)

Active Ingredient: OnabotulinumtoxinA which blocks neuromuscular transmission by binding to receptor sites on motor nerve terminals, entering the nerve and inhibiting the release of acetylcholine producing partial chemical denervation of the muscle resulting in temporary localized reduction in muscle activity.

STORAGE

Should be stored in the refrigerator before and after reconstitution 2.2 Preparation and Dilution Technique BOTOX Cosmetic is supplied in single-dose 50 Units and 100 Units per vial. Prior to intramuscular injection, reco DILUTION & RECONSTITUTION vacuum-dried vial of BOTOX Cosmetic with sterile, preservative-free 0.9% Sodium Chloride Injection USP (see T • Recon with only sterile, preservativethe proper amount of diluent in the appropriate size needle and syringe to obtain a reconstituted solution at a conce free 0.9% Sodium Chloride (NaCl) 4 Units/0.1 mL and a total treatment dose of 20 Units in 0.5 mL for glabellar lines, 24 Units in 0.6 mL for lateral ca • Always record date and time 40 Units in 1 mL for forehead lines and glabellar lines. Then slowly inject the diluent into the vial. Discard the vial not reconstituted pull the diluent into the vial. Gently mix BOTOX Cosmetic with the saline by rotating the vial. Record the date • 100 Unit Recon 2.5mlBOTOX NaCl Cosmetic should be administered within 24 hours after reconstitu reconstitution onvialthe space onwith the label.

• 50 Unit vialRecon with 1.25 ml NaCl time period, reconstituted BOTOX Cosmetic should be stored in a refrigerator (2° to 8°C). BOTOX Cosmetic vials • Gently mix Botox Cosmetic with NaCl only. Discard any remaining solution. by rotating the vial • 1: Reconstitution yields 4 for units/.1mL Table Dilution Instructions BOTOX Cosmetic Vials (100 Units and 50 Units) Diluent* Added to Resulting Dose Diluent* Added to Resulting Dose 100 Unit Vial Units per 0.1 mL 50 Unit Vial Units per 0.1 mL

2.5 mL

4 Units

1.25 mL

4 Units

*Preservative-free 0.9% Sodium Chloride Injection, USP Only

Reconstituted BOTOX CosmeticON should be clear, colorless,AREA and free & of particulate matter. Parenteral DOSAGEDEPENDENT TREATMENT INDIVIDUAL BASISdrug products

When identifying the location of the appropriate injection sites in the frontalis muscle, assess the overall relationship between the siz

the subject’s forehead, the distribution of frontalis muscle activity. inspected visually for particulate matter and is discoloration prior toandadministration and whenever the solution and the • Forehead: Recommended dosage 10-20 ofUnits Locate the following horizontal treatment rows by light palpation of the at rest and maximum eyebrow elevation: Do • not Glabella: freeze reconstituted BOTOX Cosmetic.

Recommended dosage is 20 units • Superior Margin of Frontalis Activity: approximately 1 cm aboveforehead the most superior forehead crease • Lower Treatment Row: midway between the superior margin of frontalis activity and the eyebrow, at least 2 cm above the eyebrowwith 6 injection points • Crow’s Feet: Recommend 24 units (12U per side) • Upper Treatment Row: midway between the superior margin of frontalis activity and lower treatment row 2.3 Administration 4 Units (0.1 mL) of reconstituted BOTOX Cosmetic into 5 sites in the frontalis muscle, for a total of 20 Units (0.5 mL). Place Draw at least 0.5 mL (for glabellar lines), 0.6 mL (forInject lateral canthal lines), or 1 mL (for forehead lines treated in c the 5 injections at the intersection of the horizontal treatment rows with the following vertical landmarks (see Figure 4): ONSET AND DURATION • On the lower treatment row at the midline of the face, and 0.5 – 1.5 cm medial to the palpated temporal fusion line (tempor glabellar lines) of the properly reconstituted toxin into thecrest); sterile syringe, preferably a tuberculin syringe and expel for the other side.

• See results in as little as 3-7 days. May take up totherepeat 2 weeks full results.

• On upper treatment row,for midway between the lateral and medial sites on the lower treatment row; repeat for the other the syringe barrel. Remove the needle used to reconstitute the product and attach a 30-33 gauge needle. Confirm th side.

• Last 3-4 months needle.

Figure 4: Figure 1 Botox Chart

CONTRAINDICATIONS Glabellar Lines

• Known to Botulinum toxin Glabellar facialhypersensitivity lines arise from the activity of the corrugator and orbicularis oculi muscles. These muscles move th • Infection at injection sites and the procerus and depressor supercilii pull the brow inferiorly. This creates a frown or “furrowed brow”. The lo • muscles Certainvary antibiotics (aminoglycosides) of the markedly among individuals. Lines induced by facial expression occur perpendicular to the dir • Neuromuscular diseases such as Lou contracting facial muscles. An effective dose forGehrig, facial lines is determined by gross observation of the patient’s abi Myasthenia Gravis, Multiple Sclerosis, and muscle superficial muscles injected.

relaxers.

For simultaneous treatment with lateral canthal lines, the total dose is 64 Units, comprised of 20 Units for forehead lines, 20 Units fo

glabellar lines, and 24 Units for lateral canthal (see Lateral Canthal Lines Administration and Figures 2 and 3).

In order to reduce the complication of ptosis the following steps should be lines taken: THE BEGINNERS GUIDE | 5 3 DOSAGE FORMS AND STRENGTHS • Avoid injection near the levator palpebrae superioris, particularly in patients with larger brow depressor com

comparable to or lower than the maximum recommended total dose. [see Warnings and Precautions

HISTORY OF TOXINS 1 INDICATIONS AND USAGE 1.1 Cervical Dystonia DYSPORT® is indicated for the treatment of adults with cervical dystonia.

1.2

Glabellar Lines

B. DYSPORT (GALDERMA) is indicated for the temporary improvement in the appearance of moderate to severe glabellar lin DYSPORT ®

procerus and corrugator muscle activity adult patients less than 65 years of age.

Active Ingredient: AbobotulinumtoxinA which actsinon the same receptors similar to Botox but notes to have a 1.3wider Upper Limb Spasticity faster onset and muscle dispersion and for use in ® is indicated for the treatment of upper limb spasticity in adult patients, to decrease the severity o DYSPORT adults <65 years of age! in elbow flexors, wrist flexors and finger flexors.

STORAGE 1.4

Lower Limb Spasticity in Pediatric Patients Should be stored in the refrigerator after of lower limb spasticity in pediatric patients 2 years of age and ol DYSPORT® is indicatedbefore for theand treatment reconstitution 2 DOSAGE AND ADMINISTRATION DILUTION2.1 & RECONSTITUTION Instructions for Safe Use ® are specific to the preparation and assay method utilized. They are not inte Thewith potency of DYSPORT • Recon onlyUnits sterile, preservative-free preparations of botulinum toxin products and, therefore, units of biological activity of DYSPORT ® cannot be 0.9% Sodium Chloride (NaCl) converted units of time any other botulinum toxin products assessed with any other specific assay method [se • Always recordinto date and reconstituted ® is intended Reconstituted DYSPORT • 300 Unit vial- Recon with 2.5ml NaCl orfor1.5intramuscular injection only.

NaCl Reconstitution instructions are specific for each of the 300 Unit vial and the 500 Unit vial. These volumes yi • Gently mix Dysport NaClindication by rotating the1). vial specific for the usewith for each (Table • Reconstitution yields 12 units/.1mL (2.5mL recon) or 10 units/.08mL • It is easier to use the botox system of injecting and then multiple units injected by 3 to get ® 1: Dilution Instructions the totalTable number of Dysport units. for DYSPORT Vials (500 Units and 300 Units) Diluent* per 500 Resulting Dose Diluent* per 300 Unit Vial Units per 0.1 mL Unit Vial 1 mL 50 Units 0.6 mL 2 mL 25 Units -2.5 mL 20 Units 1.5 mL --2.5 mL 5 mL** 10 Units 3 mL *Preservative-free 0.9% Sodium Chloride Injection, USP Only

Resulting Dose Units per 0.1 mL 50 Units -20 Units 12 Units 10 Units

• Yields 10 units/ .05 mL (1.5mL recon) Note: These dilutions are calculated for an injection volume of 0.1 mL. A decrease ® DOSAGE- or DEPENDENT ON TREATMENT AREA & INDIVIDUAL increase in the DYSPORT dose is also possible by administering a smaller or • Forehead: Recommended dosage is 20-50 Units in dose), 0.08 mL (20% larger injection volume (i.e.

0.05 mL (50% decrease • Glabella: Recommended dosage is 50 units in dose)). decrease in dose) or 0.15 mL (50% increase • Crow’s Feet: Recommend 30 units (15U per side) with 6 injection points ** When using 5 mL of diluent for a 500 Unit vial of DYSPORT®, complete the

BASIS

ONSET AND DURATION

• See results in as little as 2-5 days • Last 3-5 months

Reference ID: 4020878 CONTRAINDICATIONS

• Hypersensitivity to any botulinum toxin • Allergy to cow’s milk protein • Infection at injection sites • Certain antibiotics (aminoglycosides) • Neuromuscular diseases such as Lou Gehrig, Myasthenia Gravis, Multiple Sclerosis, and muscle relaxers.

QUEEN THE AESTHETIC INJECTOR

C. JEUVEAU (EVOLUS)

Active Ingredient: PrabotulinumtoxinA-xvfs which is the newest toxin on the market and known as the “modern-made” tox. Similar to the other toxins with the mechanism of action to temporarily reduce fine lines and wrinkles for aesthetic use only.

STORAGE

Should be stored in the refrigerator before and after reconstitution

DILUTION & RECONSTITUTION

• Recon with only sterile, preservativefree 0.9% Sodium Chloride (NaCl) • Always record date and time reconstituted • 100 Unit vial- Recon with 2.5ml NaCl • Gently mix Jeuveau Cosmetic with NaCl by rotating the vial • Reconstitution yields 4 units/.1mL

DOSAGE- DEPENDENT ON TREATMENT AREA & INDIVIDUAL BASIS • Forehead: Recommended dosage is 10-20 Units • Glabella: Recommended dosage is 20 units • Crow’s Feet: Recommend 24 units (12U per side) with 6 injection points

ONSET AND DURATION

• See results in as little as 5-7 days • Lasts 3-4 months

CONTRAINDICATIONS

• Allergy to any of the ingredients (botulinum and serum albumin) • Injection site infection • <18 years old • Certain antibiotics (aminoglycosides) • Neuromuscular diseases such as Lou Gehrig, Myasthenia Gravis, Multiple Sclerosis, and muscle relaxers.

THE BEGINNERS GUIDE | 7

HISTORY OF TOXINS

D. XEOMIN (MERZ)

Active Ingredient: IncobotulinumtoxinA is another toxin used to treat both cosmetic and medical conditions. Does not have to be refrigerated until after reconstitution.

PATIENT ASSESSMENT Worksheet

• Full H&P for new clients (include medications, Muscles allergies, cosmeticFacial procedures) • Assess for asymmetries and document • Be aware of older and geriatric clients and their skin laxity, tissue integrity, and muscle movement • Always take before pictures and have the patient follow-up in 2 weeks with after pictures

ANATOMY

Figure 1 Musculature Diagram

Figure 2 Facial Anatomy and Neurovasculature Learn anatomy faster and more effectively at www.kenhub.com

QUEEN THE AESTHETIC INJECTOR

the following horizontal treatment rows by light palpation of the forehead at rest and maximum eyebrow elevation: Superior Margin of Frontalis Activity: approximately 1 cm above the most superior forehead crease MUSCLE) LowerFOREHEAD Treatment Row: (FRONTALIS midway between the superior margin of frontalis activity and the eyebrow, at least 2 cm above th • This muscle moves the brow superiorly and interacts with the procerus, corrugator, eyebrow depressor supercilii,between and orbicularis.

Contraction this muscle can aidlower in brow elevation Upper Treatment Row: midway the superior margin of of frontalis activity and treatment row 1. Always treat forehead lines in conjunction with glabella to minimize the potential for brow ptosisBOTOX (droopyCosmetic eyelid). into 5 sites in the frontalis muscle, for a total of 20 Units (0.5 mL). Pla 4 Units (0.1 mL) of reconstituted • Injection Location jections at the intersection of the horizontal treatment rows with the following vertical landmarks (see Figure 4): 1. Locate injection points by having patient raise eyebrows as high as possible and at rest On the lower treatment row at the midline of the face, and 0.5 – 1.5 cm medial to the palpated temporal fusion line (temp (static vs. dynamic) crest); repeat for the other side.

A. Use marking pencil to identify injection areas On the upper treatment row, midway between the lateral and medial sites on the lower treatment row; repeat for the othe B. 1st injection point should be lined up with pupils side.

C. Always observe and evaluate the height of the brows.

D. AVOID BROW PTOSIS! Inject >2 cm above the eyebrow/supraorbital ridge* 4:

multaneous treatment with canthal lines, the total dose is laterally 64 Units,<2cm comprised 20supraorbital Units for forehead E. lateral Be cognizant of injecting too far aboveofthe ridge lines, 20 Unit ar lines, and 242.

Units for lateral canthal the linesoverall (see Lateral Lines forehead Administration and Figures 2 and 3).

Important to assess size ofCanthal the patient’s and the distribution of the frontalis muscle activity DOSAGE FORMS AND STRENGTHS 3. Intramuscular injection with needle insertion at a 30-45 degree angle.

4. Superior margin- locate 1st furrow and mark above the first full furrow activity, approximately For injection: 50 Units, powder in a single-dose vial for reconstitution 1 cmvacuum-dried above the most superior forehead crease For injection:5. 100 Units,margin vacuum-dried powder a single-dose vial for reconstitution Lower (treatment row)-inlocate most inferior furrow which could be midway between the superior margin and the eyebrow, remembering to stay at least 2cm above the CONTRAINDICATIONS eyebrow 6. Upper margin (treatment row): half-way between the superior and lower margin of frontalis Known Hypersensitivity activityto Botulinum Toxin A. There should be about 4-7hypersensitivity spaced out injection whichtoxin yieldpreparation about 2-4 units X Cosmetic is contraindicated in individuals with known to any sites botulinum or to any of th per injection over both upper and lower margin treatment rows. nents in the formulation [see Warnings and site Precautions (5.4)].

Infection at the Injection Site(s) X Cosmetic is contraindicated in the presence of infection at the proposed injection site(s).

WARNINGS AND PRECAUTIONS

Lack of Interchangeability between Botulinum Toxin Products tency Units of BOTOX Cosmetic are specific to the preparation and assay method They are not interchangeable w THEutilized.

BEGINNERS GUIDE |9 reparations of botulinum toxin products and, therefore, units of biological activity of BOTOX Cosmetic cannot be compar

FROWN LINES/11S/GLABELLA (PROCERUS AND CORRUGATOR MUSCLE)

A. The activity of the corrugator is a series of muscles that move the brow medially (corrugator and orbicularis oculi) and inferiorly (procerus and depressor supercilii) B. Medial and lateral canthus can serve as landmarks when marking out injection points.

Figure 1: C. Intramuscular injection with needle insertion perpendicular at a 90-degree angle.

D. 5 injection sites that yield about 4 units per injection site. 2 in each corrugator muscle To inject DYSPORT , advance the needle through muscle the skin into the underlying muscle while applying finger pressure on the superior (lateral and medial) medial and 1 in the procerus orbital rim. Inject patients with a total of 50 Units in five equally divided aliquots. Using a 30 gauge needle, inject 10 Units of DYSPORT into each of five sites, two in each corrugator muscle, and one in the procerus muscle (see Figure 1).

E. Do not inject lateral corrugator less than 1 cm above supraorbital ridge or closer Figure 1 than 1 cm above central brow ®

®

Lateral Canthal Lines 2.4 Dosing in Upper Limb Spasticity in Adult Patients Lateral canthal lines arise largely from the activity of the orbicularis oculi muscles around the eye responsible for blinking and eyelid Special Populations closure. ForcefulAdults contraction of the orbicularis oculi results in lateral and radially oriented folds (crow’s feet lines) which originate Dosing in initial subsequent treatment sessions shouldlines be tailored to theamong individualpatients. based on the size, number and location of the lateralbe canthus.

Theandseverity distribution of these radial differs markfrom should ininvolved, the center of the area maximal wrinkling. injections muscles of spasticity, the presence of local of muscle weakness, the patient's response to previousOther treatment, and/or

CROWS FEET (ORBICULARIS OCULI MUSCLE)

• The first adverse event history with botulinum toxins. In the pivotal clinical trial, doses of 500 Units and 1000 Units were divided among should be about Injections 1-1.5cm above and below first injection selected muscles, Table 2 and Figure 2, at a given treatment should be given with the needle bevel tip up andsession. oriented away from the eye. Inject 4 Units/0.1 mL of reconstituted BOTOX Cosmetic into 3 sites per side (6 total injection points) in the site. lateral orbicularis oculi muscle for a total of 24 Units/0.6 No more than 1 mL should at any single angle injection • Injections are superficial andgenerally at abe administered 30-degree with a needle pointed away from mL (12 Units per side). The first injection (A) should be approximately 1.5-2.0 cm temporal to the lateral canthus and just temporal to the the eye. Should outside thecanthal orbital orbital rim.be If the lines in theof lateral regionrim. are above and below the lateral canthus, inject per Figure 2. Alternatively, if the Table 2: DYSPORT Dosing by Muscle for Upper Limb Spasticity in Adult Patients lines in the lateral canthal region are primarily below the lateral canthus, inject per Figure 3.

Injected Dose Recommended Number of • 3 injection sites Muscles about 2- 4 units per Recommended site. ®

Figure 2:

Flexor carpi radialis (FCR) Flexor carpi ulnaris (FCU) Flexor digitorum profundus (FDP) Flexor digitorum superficialis (FDS) Brachialis Brachioradialis Biceps Brachii (BB) Pronator Teres

DYSPORT® 100 Units to 2003: Units Figure 100 Units to 200 Units 100 Units to 200 Units 100 Units to 200 Units 200 Units to 400 Units 100 Units to 200 Units 200 Units to 400 Units 100 Units to 200 Units

Injection(s) per Muscle 1 to 2 1 to 2 1 to 2 1 to 2 1 to 2 1 to 2 1 to 2 1

Reference ID: 4020878

OTHER USES: • • • • • • •

For simultaneous treatment with glabellar lines, the dose is 24 Units for lateral canthal lines and 20 Units for glabellar lines (see Glabellar Lines Administration and Figure 1), with a total dose of 44 Units.

ADVERSE REACTIONS:

Lip flip • Brow Ptosis (most common) Forehead Lines Forehead lines arise largely from the activity of muscles.

This muscle moves the brow superiorly, interacting with the Depressor Anguli Oris (DAO) • the frontalis Eyelid edema procerus, orbicularis, corrugator, and depressor supercilli. Frontalis contraction causes brow elevation. The location, size, and use of Masseter the muscles vary markedly among individuals. • Vision disturbances Eyebrow lift Treat forehead lines in conjunction with glabellar • linesHeadache (see Glabellar Lines Administration and Figure 1) to minimize the potential for Chin dimplingbrow ptosis. The recommended total dose for treatment • Injection site(20 redness, bumps or lumps of forehead lines Units [0.5 mL]) in conjunction with glabellar lines (20 Units [0.5 mL]) is 40 Units (1mL).

Platysmal neck bands • Hypersensitivity reaction Hyperhidrosis • Migration of toxin • Dysphagia and breathing difficulties • Drug interactions (aminoglycosides, muscle relaxants)

QUEEN THE AESTHETIC INJECTOR

NOTES section

THE BEGINNERS GUIDE | 11

POST-PROCEDURE

do’s and dont’s

BRUISING

This may last a couple of days to weeks. Arnika Forte contains bromelain which helps decrease the duration of bruising time and severity. Avoiding NSAIDs, blood thinning vitamins, and alcohol can prevent hematomas or contusions as well as speed healing time. However, if you are taking anticoagulant therapy prescribed by your MD for any medical conditions please continue. FYI- Many medications and vitamins are considered blood thinning.

• Do not lie down for 3-4 hours following treatment.

• Keep your head in a neutral position for the rest of the day without bending the head forward or down. By following these precautionary measures, you will minimize the occurrence of ptosis (droopy eyelids), and less than optimal outcomes.

• Avoid manipulation of the treated area for the rest of the day such as the use of a Clarisonic brush, scrubbing, rubbing, or pressing of the treated areas. DO NOT massage treatment areas.

• No exercise for 24-48 hours following treatment. Anything that causes heat or increases blood pressure will likely metabolize the product faster: i.e. hot yoga, pilates, saunas, steam rooms, infrared sauna, high impact exercise, hyperhidrosis, hypertension, hyperthyroidism, stress, etc.

COMMON SIDE EFFECTS

• Headache • Temporary bruising • Temporary swelling • Bleeding at the injection site • Temporary muscle weakness/paralysis at or near the injection site • Ptosis- typically resolves in 2-4 weeks.

• Flu-like symptoms or coryza- typically resolves spontaneously in 12-24hours

UNCOMMON SIDE EFFECTS • Skin rash • Back pain • Neck pain

LESS COMMON BUT SERIOUS SIDE EFFECTS • • • •

Visual disturbances, corneal inflammation Difficulty swallowing Difficulty breathing Severe facial swelling

QUEEN THE AESTHETIC INJECTOR

Figure 1 Before & After Treatment

INJECTION TIPS

• Most commonly used syringes are a TB syringe and an Insulin syringe • Always properly clean and sanitization skin with alcohol swabs before injections • Numbing cream may be applied before sanitation for about 4-7 minutes for comfort • Ice can be applied to the area • Inject needle perpendicular • A vibrating distractor can be held by the patient or assistant when injecting • Hold treatment area between thumb and index finger when injecting • A small bump at the injection site is common after injection and normally disappear within 10-20 minutes post-injection

TROUBLESHOOTING • If a patient has ptosis can prescribe apraclonidine .5% (2 drops in affected eye TID) eye drops that have been shown to help combat ptosis and elevate eyelid 1-3 mm.

• Contraindications: a history of glaucoma, retinal detachment, any eye history including surgeries • Can also use the back of an electric toothbrush to the affected eye 3 times a day to increase lymphatic drainage and increase the breakdown of molecules to aid in eyelid ptosis.

• Vessel occlusion is less likely when using neurotoxins

TIPS & TRICKS • We can always add BUT we cannot take away! Start low and go slow!

• Always remember individual results may vary!

Figure 1 Muscle Expression Lines

THE BEGINNERS GUIDE | 13

SUBMENTAL FAT

KYBELLA (ALLERGAN)

Active Ingredient: Deoxycholic Acid is a bile acid that is a naturally occurring molecule that breaks down and absorbs dietary fat in the body.

The synthetic version is administered as a series of injections under the chin (submental fat), permanently destroying fat cells and producing gradual results over time. “Double chin” be gone! Once destroyed the cells can no longer accumulate or store fat.

STORAGE

Should be stored at room temperature

DILUTION & RECONSTITUTION

• Vial is 2mL and no need to reconstitute • 10mg/mL

DOSAGE- DEPENDENT ON TREATMENT AREA & INDIVIDUAL BASIS

• .2mL to be injected into treatment areas 1 cm apart (30 g or smaller, 0.5inch needle) • When assessing the treatment area use the chin profile and locate submandibular glands laterally and the position of the hyoid bone as well as the borders of the SCM. • Spacing guides are provided and can be used and normally a translation of the number of dots is clinical to how many vials are needed

Figure 1 Before & After Treatment

QUEEN THE AESTHETIC INJECTOR

ONSET AND DURATION

• Requires multiple treatments, visible results in 2-4 treatments with treatments spaced 4-6 weeks apart • Permanent-further treatment not expected once reach treatment goal reached

CONTRAINDICATIONS • • • •

Allergy to any of the ingredients Injection site infection <18 years old Any cosmetic treatments or surgeries to face, neck or chin should be thoroughly discussed

KYBELLA SIDE EFFECTS

• Most common 1. Swelling, pain, numbness, tenderness 2. Hardness in the treatment area • Series side effects 1. Marginal mandibular nerve injury in the jaw (can cause an uneven smile or facial muscle weakness) 2. Injection site problems including necrosis around the injection sites, ulcers

Treat With the Established Dosing Standard

Determine the dose by counting the number of dots in the Treatment Zone SPACING GUIDE Customize and apply the spacing guide in the patient’s Treatment Zone you have identified and plan your injections accordingly. Each injection must be spaced 1 cm apart.5 No more than a total of 50 injections in the patient’s Treatment Zone.5 Use alcohol to remove any grid dots that fall outside the patient’s Treatment Zone.

Perforations

Translating dots to vials1 0.2 mL per injection site1

Number of dots

Total dose (mL)

Number of vials

10

2

1

20

4

2

30

6

3

40

8

4

50

10

5

a

Average dosing range per treatment session in clinical trials5

Discard unused portion of vials.5

a

IMPORTANT SAFETY INFORMATION (continued)

THE CONTRAINDICATIONS KYBELLA® is contraindicated in the presence of infection at the injection sites.

BEGINNERS GUIDE | 15

FACIAL MUSCLES

Learn anatomy faster and more effectively at www.kenhub.com QUEEN THE AESTHETIC INJECTOR

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THE BEGINNERS GUIDE | 17

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QUEEN THE AESTHETIC INJECTOR

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THE BEGINNERS GUIDE | 19

THANK YOU let’s connect

Hey!!! I’m Simone “Queen” Hopes, a Houston, TX native and Physician Assistant. This road has not been easy but worth it. From struggles through PA school, losing accreditation during my PA education, pushing past the “no’s” and hard work, WE MADE IT! God has truly covered me and provided his continued guidance and love throughout life and I am forever grateful. As a first-generation college graduate and medical professional, I’ve found myself as a mentor and confidant to many around me.

I wouldn’t be here without God’s guidance and grace. My family continues to support every single endeavor. I have unwavering love and support from my friends as well. I believe you are only as strong as your faith, your hustle, your will to survive, and your support system.

As a Surgical Physician Assistant, I believe my medical knowledge sets me up perfectly to start my own injection business. As an aesthetic injector providing beauty tips and enhancing injections, my medical background allows me the knowledge to ensure proven results. It takes a skillful eye to know where and how to inject and the knowledge to understand the anatomy and functions of muscles and vasculature. After multiple years of school and training, I never took “no” for an answer. When challenges present themselves, you have to use them as fuel to propel you to the next level. Don’t become discouraged by setbacks.

When people think of my brand I want them to think: Result Driven. Realistic. Relatable. Rejuvenating.

I have an aesthetic eye. I remain honest and provide realistic results for those I encounter. When people think of Queen The Aesthetic Injector, I want them to think of quality and realistic beauty enhancements with an alluring vibe.

As a black woman who grew up with “just enough”, it was imperative for me to have this course. I wanted to be able to provide supplemental income opportunities for medical professionals. The earning potential is uncapped and as long as you have a great heart, open mind, and a skilled hand, you will always have clients. I truly thank you for believing in my vision and taking the course. You will always have a friend and mentor in me. Let’s stay connected.

Queen

THE BEGINNERS GUIDE TO AESTHETIC INJECTIONS

BY SIMONE HOPES, PA-C Queen The Aesthetic Injector

@queentheinjector #QueenAesthetics #QueenCourseEssentials

QUEEN THE AESTHETIC INJECTOR