Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations From the American Society for Dermatologic Surgery Multidisciplinary Task Force

Jones, Derek; Fitzgerald, Rebecca; Cox, Sue Ellen; Butterwick, Kimberly J.; Murad, Mohammad Hassan; Humphrey, Shannon; Carruthers, Jean; Dayan, Steven H.; Donofrio, Lisa; Solish, Nowell; Yee, Gilbert; Alam, Murad

doi:10.1097/dss.0000000000002921

Cited by 40 publications

(77 citation statements)

References 99 publications

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“…Although both needles and cannulas can be used to volumize the midface, cannulas may be safer and minimize the risk of intravascular complications. 15,27,28 To optimize the volume of product injected into the midface and en-…”

Section: Discussionmentioning

confidence: 99%

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Injection techniques for midface volumization using soft tissue hyaluronic acid fillers designed for dynamic facial movement

Galadari

Weinkle

2021

J of Cosmetic Dermatology

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Rejuvenating the aging face is one of the great challenges in the field of aesthetic dermatology, and volume reflation is essential to improve aesthetic outcomes. [1][2][3] Volume reflation and volume enhancement can alter facial contours and balance to counteract the effects of aging. 2 Midface volumization is of particular importance, as the midface has a considerable impact on how one looks, especially since people tend to look at other people just below the eyes. 4 Well-contoured and balanced fullness in the midface exemplifies a

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Section: Discussionmentioning

confidence: 99%

“…Injectors must have a deep understanding of facial anatomy and product characteristics to minimize the risk of complications and achieve desired outcomes. Although both needles and cannulas can be used to volumize the midface, cannulas may be safer and minimize the risk of intravascular complications 15,27,28 …”

Section: Discussionmentioning

confidence: 99%

Injection techniques for midface volumization using soft tissue hyaluronic acid fillers designed for dynamic facial movement

Galadari

Weinkle

2021

J of Cosmetic Dermatology

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“…2 Whether aspiration is practiced or not, the practitioner should be vigilant of the following signs that can occur with relative immediacy after occlusion of a vessel: disproportionate pain, pallor or tissue blanching, and slow capillary refill. 2–5 A reticular, livedoid, or mottled skin appearance, a blue or blue–gray appearance of the skin, and asymmetric edema tend to occur several minutes to hours after occlusion (Figure 1). 2,3,5…”

Section: Recognition and Evaluation Of Cutaneous Vascular Occlusionmentioning

confidence: 99%

Cutaneous Vascular Compromise and Resolution of Skin Barrier Breakdown After Dermal Filler Occlusion—Implementation of Evidence-Based Recommendations Into Real-World Clinical Practice

et al. 2022

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BACKGROUND Vascular occlusions that threaten skin integrity, although not an emergency like those that threaten a patient's vision, is an urgent situation. Accurately interpreting physical examination findings is paramount. The use of highdose, pulsed hyaluronidase is the mainstay of therapy; however, adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and hyperbaric oxygen should be considered. OBJECTIVE To provide a review of the literature on the treatment of vascular occlusions threatening skin barrier integrity and develop a step-wise treatment guide. MATERIALS AND METHODS The authors searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords. RESULTS Twenty-six articles focusing on vascular occlusions threatening the skin barrier were reviewed. The authors collectively agreed on treatments to reverse vascular occlusions and restore the skin barrier. The importance of high-dose, pulsed hyaluronidase was clear. Therapies that lacked evidence such as sodium thiosulfate were also revealed. CONCLUSION A vascular occlusion that threatens skin integrity is an urgent matter which requires accurate interpretation of physical examination findings that will help guide intervention. High-dose, pulsed hyaluronidase along with adjunctive measures performed in a step-wise manner is key to an optimal outcome.

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“…The most significant adverse events can occur at the time of injection, such as vascular occlusions and blindness. 1 , 2 Other adverse events include those that develop soon after the treatment, such as infection, or those that occur several months later, with the appearance of inflammatory nodular reactions.…”

Section: Introductionmentioning

confidence: 99%

Soft Tissue Filler Therapy and Informed Consent: A Canadian Review

Arlette

Froese²,

Singh³

2021

J Cutan Med Surg

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Soft Tissue Filler (STF) Therapy for cosmetic facial rejuvenation is associated with known complications. The manifestation of these known complications can lead to patients commencing civil litigation actions or making complaints to provincial regulatory authorities and alleging that the practitioner failed to obtain the patient’s informed consent to the therapy. Data provided by the Canadian Medical Protective Association (CMPA) on medical-legal cases arising from the provision of STF therapy between 2005 and 2019 are presented. Select reported case law decisions from Canadian courts and regulatory bodies addressing the concept of informed consent are reviewed. Insights about the risk factors pertaining to the process of obtaining informed consent for STF therapy are presented to increase an understanding of the elements of communication and documentation needed to ensure patients are aware of the consequences of this treatment.

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Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations From the American Society for Dermatologic Surgery Multidisciplinary Task Force

Cited by 40 publications

References 99 publications

Injection techniques for midface volumization using soft tissue hyaluronic acid fillers designed for dynamic facial movement

Injection techniques for midface volumization using soft tissue hyaluronic acid fillers designed for dynamic facial movement

Cutaneous Vascular Compromise and Resolution of Skin Barrier Breakdown After Dermal Filler Occlusion—Implementation of Evidence-Based Recommendations Into Real-World Clinical Practice

Soft Tissue Filler Therapy and Informed Consent: A Canadian Review

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