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Controlling for Complications From Injections

Given the nature of performing a procedure, cosmetic dermatologists are cognizant of the possibility for complications in aesthetic practice. “There are all kinds of complications; there are the ones that we see commonly, there are ones that we see uncommonly, and there are ones that keep you awake at night,” explained Kenneth Beer, MD, founder of Cosmetic Bootcamp, at the Cosmetic Bootcamp Virtual Meeting on July 11, 2020.

The more common problems, explained Dr Beer, are beading, blue nodules or lines, and bumps. For example, these can occur when hyaluronic acid (HA) is injected too superficially in the undereye area. Because of the reflection of light on the superficial injection, the tear troughs can appear bluish; while this is not difficult to correct with hyaluronidase, said Dr Beer, it can be tedious to continually bring in the patient.

Bruising from HA filler is also very common and frequently listed on package inserts. Treatment of bruising is very amendable to pulse dye on low settings. “If you get a call from a patient with a linear bruise, bring them in to evaluate,” suggested Dr Beer. Bruising can also be a differential diagnosis for necrosis, so it’s critical to examine the patient and consider hyaluronidase if the bruising is suspicious.

Another less common complication is an allergic reaction, which can be treated rather quickly.

For the serious complications, aesthetic specialists should be concerned with embolization via introduction into the vasculature. This event can lead to the necrosis of the region, which can further complicate into blindness, cerebral ischemia, or bleeding, but also superficial necrosis and scarring from the compromise of the blood vessels.

To reduce complication risk, Dr Beer suggested a few anatomical factors to consider. First, aesthetic specialists should avoid the supratrochlear artery and the supraorbital artery. “If you’re injecting in those areas, you want to be careful to be superficial and use a very small needle,” said Dr Beer.

For the nasolabial fold, the facial artery can be of concern as well. Dr Beer noted how the facial artery runs close by the nasolabial fold, though physicians can keep in mind that the upper third of the facial artery tends to be superficial while the lower two-thirds run deeper beneath the muscle or deeper subcutaneous tissue.

The nose should also be noted as a high-risk area for cosmetic complications due to the number of arteries that run near the area. Similarly, the lips offer some danger zones as well due to the superior labial artery.

Temporal region complications can be very concerning as well, said Dr Beer. “When you’re injecting to fill the temple, what you want to do is stay on the periosteum and try to inject really slowly. Aspirate every few seconds just to make sure you are!”

Prevention vascular complications can be avoided, said Dr Beer, with slow injections with low pressure, injections of small amounts, and aspiration prior to injection. It’s better to deal with complications early and to the best of your ability to avoid further problems.

Read more insights from CBC 2020 at our Cosmetic Bootcamp Insights page.

Beer K. Avoiding complications. Presented at: Cosmetic Bootcamp Virtual Meeting; July 11, 2020.

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