RA self study (hypodermic tissue building)

hypodermic tissue building

a "post operative" treatment to correct signs of emaciation/dehydration in the tissues of the head, face, neck and hands.

dehydration

a reduction from normal tissue moisture content

emaciation of the back of hand

a. emaciation in this area is visually evidenced by hollows and/ or long dark shadows b. points of entry: deep insertion points between the knuckles

emaciation

excessive leanness; a "wasted" condition

sunken upper integumentary lip

points of entry a. both ends of the line of mouth closure b. both anterior nares

sunken lower integumentary lip

points of entry 1. both ends of the line of mouth closure

emaciated pad of the fingertip

points of entry: alongside the finger joints

emactiated fingers

points of entry: alongside the finger joints 1. using the same point of entry, turn the needle to treat the full length of the finger

liquid colloid

the liquid colloid is currently acknowledged as the superior tissue builder, but its effects are largely permanent. the liquid colloid tissue builder requires contact with moisture in order to form dense gel the hypo syringe and needle must be cleaned with an appropriate solvent a narrow gauge hype needle is suitable for use when injecting the liquid colloid as a tissue builder

substitute materials

A. a humectant can be used for tissue building purposes for a short time only B. substitute materials usually gravitate to deeper tissues after a number of hours, the concavity generally re appears, and re injection of the area is required

massage cream

A. a small amount of mineral oil should be mixed with massage cream so that it is more easily injected B. a larger gauge hypo needle is commonly used when injecting massage cream as a tissue builder C. because of the tendency of massage cream to settle out to deeper tissues, anticipate that the concavity will eventually re appear, requiring additional injection at a later time D. trichloroethylene (household spot remover) can be effectively used to remove trace elements of massage cream and oil for the hypo syringe and needle

Why tissue building should NOT be done before embalming.

A. the embalming process itself may erase most of the visible signs of emaciation by replacing moisture in the tissues. B. accurate requirements as to the amount of tissue builder required cannot be predetermined before the embalming operation is completed C. inserting a hypodermic needle into tissues creates an area of low resistance. D. a modifying agent, such as a humectant, could be added to the embalming chemical to serve as an internal tissue builder

general procedures

A. the hypodermic needle should be inserted to the most distant point of the concavity before injecting any tissue builder B. tissue builder should be injected as close to the surface as possible; injection into deeper tissues is not effective in altering surface form 1. use your "free" hand to estimate needle depth and to avoid puncturing the skin C. the end of the hypodermic needle will commonly be blocked with subcutaneous tissues after insertion; withdraw the needle approximately 1/8th inch before injecting tissue builder D. withdraw the needle slowly from the most distant point of the concavity to the point of entry while depositing tissue builder E. apply external pressure with your "free hand" to distribute any clumps of tissue builder that develop, a condition that is quite common when using the liquid colloid form of tissue builder F. when selecting a point of entry for the hypodermic needle, use a point that does not permit the gravitation seepage of filling materials onto clothing G. when using the liquid colloid form of tissue builder, clean the hypodermic syringe and the needle with the special solvent that is usually supplied with it 1. cuticle remover can be used for the same purpose in an emergency

sunken submandibular area

1. a common fault of tissue building is to neglect the area below the jawling 2. points of entry: behing both angles of the jaw a. the hypodermic needle must be long enough to reach the midline of the neck below the chin

Cases that DO justify hypo.

1. a lingering illness that produces marked changes in appearance over a relatively short period of time 2. a disease that causes rapid dehydration, robbing the cells of much of their normal moisture content ***natural aging DOES NOT justify hypo treatment.

sunken cheek

1. because of the size and curvature of this area, two opposite points of entry are usually necessary to reach all parts of the depression 2. the cheek (buccal) area is a naturally depressed area; exercise care when altering its form 3. when filling a sunken cheek, be sure to maintain the normal prominence of the nasolabial fold against the upper integumentary lip a. with your "free hand", exert slight pressure along the "mouth side" of the nasolabial fold to contain tissue filler in the cheek area Points of entry a. the nostril opening b. the corner of the mouth c. behind the lobe of the ear d. behind the tragus of the ear e. behind the upper part of the jawline 4. be sure to use opposite combinations of the recommended points of entry ("a" along with "c", "d", or "e" OR "b" along with "c", "d", or "e") in order to reach all parts of the depressed area

sunken eyes

1. only a small amount of tissue builder should be injected behind the eyeball to restore natural projection to the eye 2. point of entry: between the margins of the inner canthus of the eye

sunken supraorbital area

1. the supraorbital area is a convex area resting between the attached margin of the upper eyelid and the supraorbital margin 2. point of entry: several punctures made along the inferior linear margin of the eyebrow 3. use the fingers of your "free hand" and apply slight pressure on the upper eyelid; this will prevent accidental seepage of the tissue building down into the lid itself.

sunken temple

1. the temporal area is a naturally depressed area; exercise care when altering its form 2. points of entry: a. the latera portion of the eyebrow b. the sideburn c. the marginal hairling of the temple d. behind the top of the ear e. behind the anterior part of the helix

separated mucous membranes

1. when compared to lip waxing, hypodermic tissue building provides a more natural appearing solution when correcting lip separations 2. desiccated mucous membranes are boid of moisture and can only be effectively restored by total surgical excision and rebuilding with wax 3. injection of the upper mucous membrane alone may easily correct a lip separation 4. Points of entry: both ends of the line of mouth closure

Points to remember

A. the major fault in hypo is over filling similar structures on opposite sides of the face B. always UNDERESTIMATE the amount of tissue builder required until opposing areas are injected, and always inject tissue builder in SMALL QUANTITIES. C. because a needle puncture will turn dark when exposed to air, always use a hidden point of entry for the hypo needle when injecting tissue builder. ****in some areas requiring tissue building, a single point of entry is generally sufficient to reach all parts of the emaciated or dehydrated area ****because of their size and curvature, some areas may require two or more points of entry for the hypo needle