Experience and Management of Intravascular Injection with Facial Fillers: Results of a Multinational Survey of Experienced Injectors

Goodman, Greg; Roberts, Stefania; Callan, Peter

doi:10.1007/s00266-016-0658-1

Cited by 73 publications

(60 citation statements)

References 18 publications

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“…The results of an internet-based survey conducted on 52 experienced injectors worldwide showed that a 62% of them reported one or more intravascular injections [ 32 ]. Recognition of a vascular event and swift and aggressive treatment is necessary to avoid potentially irreversible complications [ 33 – 36 ].…”

Section: Resultsmentioning

confidence: 99%

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

Urdiales-Gálvez

Delgado²,

Figueiredo³

et al. 2018

Aesth Plast Surg

243

297

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BackgroundDermal fillers have been increasingly used in minimally invasive facial esthetic procedures. This widespread use has led to a rise in reports of associated complications. The aim of this expert consensus report is to describe potential adverse events associated with dermal fillers and to provide guidance on their treatment and avoidance.MethodsA multidisciplinary group of experts in esthetic treatments convened to discuss the management of the complications associated with dermal fillers use. A search was performed for English, French, and Spanish language articles in MEDLINE, the Cochrane Database, and Google Scholar using the search terms “complications” OR “soft filler complications” OR “injectable complications” AND “dermal fillers” AND “Therapy”. An initial document was drafted by the Coordinating Committee, and it was reviewed and modified by the experts, until a final text was agreed upon and validated.ResultsThe panel addressed consensus recommendations about the classification of filler complications according to the time of onset and about the clinical management of different complications including bruising, swelling, edema, infections, lumps and bumps, skin discoloration, and biofilm formation. Special attention was paid to vascular compromise and retinal artery occlusion.ConclusionsClinicians should be fully aware of the signs and symptoms related to complications and be prepared to confidently treat them. Establishing action protocols for emergencies, with agents readily available in the office, would reduce the severity of adverse outcomes associated with injection of hyaluronic acid fillers in the cosmetic setting. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for clinicians who are starting to use dermal fillers. Additionally, this document provides a better understanding about the diagnoses and management of complications if they do occur.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Section: Resultsmentioning

confidence: 99%

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

Urdiales-Gálvez

Delgado²,

Figueiredo³

et al. 2018

Aesth Plast Surg

243

297

View full text Add to dashboard Cite

show abstract

“…106,125 Time is short for the physician to intervene; prompt recognition of the problem, particularly appearance of pain, skin discoloration allows treatment to be stopped and complication treatment started immediately; topical nitropaste under occlusive dressing, high dose of hyaluronidase, oral acetylsalicylic acid (aspirin), warm compresses and vigorous massage have been recommended; secondary lines of treatment may involve hyperbaric oxygen therapy and ancillary vasodilating agents such as prostaglandin E1. [126][127][128] A metanalysis of vascular complications of facial fillers provides an interesting update. 129 To conclude, complications caused by dermal fillers are rare and mostly minor and injection-related but physicians have to be aware of the risk and be able to manage and treat adverse events, particularly the severe ones.…”

Section: Treatment Guidelines For Pcl Filler Complicationsmentioning

confidence: 99%

<p>Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics</p>

Christen¹,

Vercesi²

2020

CCID

111

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Compared to other domains, tissue engineering and esthetics have dramatically expanded in recent years, leading to both major biomedical advances and futuristic perspectives. The two share a common approach based on biomaterials, especially polymers. This paper illustrates this with the example of polycaprolactone (PCL), a polymer synthesized in the early 1930s, and one of its most recent applications, a PCL-based collagen stimulator, a filler used in esthetics. PCL is biocompatible and biodegradable. Its specific physicochemical and mechanical properties, viscoelasticity and ease of shaping led to the production of PCL-based products with various shapes and durations dependent on its biodegradation kinetics. PCL has been safely used in the biomedical field for more than 70 years, from sutures to tissue and organ replacement by 3D printing. The PCL-based collagen stimulator is composed of PCL microspheres suspended in a carboxymethyl-cellulose gel carrier providing immediate and sustained volumizing effects when injected; the morphology, the biocompatibility of the PCL microspheres embedded with the collagen fibers produced all contribute to the creation of a unique 3D scaffold for a sustained effect. Its safety has been investigated in clinical studies and vigilance surveys. Recently published experts' recommendations on injection modalities and techniques should help further optimize treatment outcome and safety. This paper also integrates reviews and recommendations on the prevention and management of adverse events related to dermal and subdermal fillers including the PCL-based collagen stimulator. In addition, in terms of efficacy and safety, this product benefits from its daily clinical use in esthetics worldwide and continuous extensive fundamental and clinical research, both on it and the PCL polymer. Forthcoming data from further investigations will reinforce knowledge of the product and procedures in the field.

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“… 38 However, even expert esthetic physicians have a substantial history of intravascular injection in their careers with 61% of trainers inducing at least one such episode. 39 …”

Section: Applied Facial Anatomymentioning

confidence: 99%

A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management

Heydenrych

Kapoor

Boulle

et al. 2018

CCID

113

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The recent rapid growth in dermal filler use, in conjunction with inadequate product and injector control, has heralded a concerning increase in filler complications. The 10-point plan has been developed to minimize complications through careful preconsideration of causative factors, categorized as patient, product, and procedure related. Patient-related factors include history, which involves a preprocedural consultation with careful elucidation of skin conditions, systemic disease, medications, and previous cosmetic procedures. Other exclusion criteria include autoimmune diseases and multiple allergies. The temporal proximity of dental or routine medical procedures is discouraged. Insightful patient assessment, with the consideration of ethnicity, gender, and generational needs, is of paramount importance. Specified informed consent is vital due to the concerning increase in vascular complications, which carry the risk for skin compromise and loss of vision. Informed consent should be signed for both adverse events and their treatment. Product-related factors include reversibility, which is a powerful advantage when using hyaluronic acid (HA) products. Complications from nonreversible or minimally degradable products, especially when layered over vital structures, are more difficult to control. Product characteristics such as HA concentration and proprietary cross-linking should be understood in the context of ideal depth, placement, and expected duration. Product layering over late or minimally degradable fillers is discouraged, while layering of HA of over the same brand, or even across brands, seems to be feasible. Procedural factors such as photographic documentation, procedural planning, aseptic technique, and anatomical and technical knowledge are of pivotal importance. A final section is dedicated to algorithms and protocols for the management and treatment of complications such as hypersensitivity, vascular events, infection, and late-onset nodules. The 10-point plan is a systematic, effective strategy aimed at reducing the risk of dermal filler complications.

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Experience and Management of Intravascular Injection with Facial Fillers: Results of a Multinational Survey of Experienced Injectors

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 73 publications

References 18 publications

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations

<p>Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics</p>

A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management

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