A Consensus on Minimizing the Risk of Hyaluronic Acid Embolic Visual Loss and Suggestions for Immediate Bedside Management

Goodman, Greg; Magnusson, Mark; Callan, Peter; Roberts, Stefania; Hart, Sarah; McDonald, Cara B; Clague, Michael; Rudd, Alice; Bekhor, Philip; Liew, Steven; Molton, Michael; Wallace, Katy; Corduff, Niamh; Arendse, Sean; Manoharan, S.; Shamban, Ava; Heydenrych, Izolda; Bhatia, Ashish C.; Peng, Ho-Jen; Pavicic, Tatjana; Kapoor, Krishan Mohan; Kosenko, David E

doi:10.1093/asj/sjz312

Cited by 48 publications

(48 citation statements)

References 43 publications

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“…Patients should be instructed to immediately report the development of nodules, both immediate and delayed, as they may result from varied aetiologies, including improper filler placement, infection or reaction to filler material . Although vascular occlusion leading to blindness is rare, patients should be explicitly advised about the risks, including all visual complications . Patients receiving injections with hyaluronic acid fillers should be clearly and explicitly educated about the types of visual disturbances that could herald a serious AE, including ocular pain, double vision or blindness in one or both eyes.…”

Section: Hyaluronic Acid Filler Treatmentsmentioning

confidence: 99%

Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes

Goodman

Liew²,

Callan

et al. 2020

Aust J Dermatology

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Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favourable safety profiles and consistent outcomes. As with any medical treatment, adverse events and complications may occur. Adverse events associated with these products are typically transient and mild to moderate in severity. Serious adverse events, such as infection and intravascular occlusion, are rare. Proper patient selection, consent and counselling, preparation and impeccable injection technique are important risk reduction strategies. Both clinicians and patients must be alert to the signs and symptoms of complications so that appropriate treatment can be started promptly. In this article, the authors review the current literature and provide their consensus recommendations for minimising adverse outcomes when treating patients with botulinum toxin or hyaluronic acid fillers.

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Section: Hyaluronic Acid Filler Treatmentsmentioning

confidence: 99%

Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes

Goodman

Liew²,

Callan

et al. 2020

Aust J Dermatology

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“…Additionally, we agree on the following consensus points for injection safety 20 : Assess skin mobility followed by a slow injection technique with low extrusion pressure. Cannulas are not considered safer for nasal injection. Micro‐boluses should be injected in small aliquots (<0.1 mL) Move the needle in the chosen plane at all times when delivering micro‐boluses, even if only in small amplitude movements. …”

Section: Injection Techniquementioning

confidence: 98%

Cannula versus needle in medical rhinoplasty: the nose knows

Rosengaus¹,

Nikolis

2020

J of Cosmetic Dermatology

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The use of hyaluronic acid (HA) fillers has become a popular alternative for nose remodeling, although poor understanding of the nasal anatomy has resulted in adverse events and generated some controversy. Among them, is the question of where and when to use cannulas vs needles. Through multiple cadaver dissections, clinical experience and the review of medical literature the authors conclude the use of needle over cannula is preferred, assuring a correct injection plane lying fully against the bone or cartilage. Although blunt in nature, cannulas may lead to difficulty in determining with precision the exact depth of product placement and contribute to more dissection of adjacent structures. Thorough knowledge of the highly variable nasal anatomy, including vessel depth location is of outmost importance in avoiding adverse events. Good patient selection is critical where most noses for augmentation rhinoplasty and some reduction rhinoplasty candidates where the goal is to camouflage the dorsal hump are amenable to medical rhinoplasty, unless there is reduced skin elasticity of nasal soft tissues or distortion of anatomy from surgery or trauma. Appropriate product selection is important for effective results. The authors suggest fillers with low cohesivity and high lifting capacity. Finally, we suggest a technique referred as Rhinosculpting base in the use the use of three conceptual elements: facial analysis, light reflection, and use of HA gel as a cartilage graft, in combination with the detailed injection technique presented in this article, which ensures a safer and satisfying treatment outcome.

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“…Aspiration of the needle prior to injection of HA filler has been suggested to prevent vascular embolism [13], although many have deemed this ineffective [14]. We suspect that the effectiveness of aspiration may depend on the technique applied.…”

Section: As) Aspiration With Proper Techniquementioning

confidence: 99%