Neither Positive Nor Negative Aspiration Before Filler Injection Should Be Relied Upon as a Safety Maneuver

Goodman, Greg; Magnusson, Mark; Callan, Peter; Roberts, Stefania; Hart, Sarah; McDonald, Cara B; Liew, Steven; Porter, C. B.; Corduff, Niamh; Clague, Michael

doi:10.1093/asj/sjaa215

Cited by 10 publications

(10 citation statements)

References 7 publications

(3 reference statements)

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“…Although the real-time clinical utility of pre-injection aspiration is controversial, [74][75][76][77][78][79][80] all injectors are ultimately aligned in avoidance of intravascular incidents. No single method guarantees safety, despite individual preference for aspiration or constant needle movement, thus the following should be borne in mind.…”

Section: The Aspiration Controversymentioning

confidence: 99%

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

Heydenrych

Boulle

Kapoor³

et al. 2021

CCID

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Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.

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Section: The Aspiration Controversymentioning

confidence: 99%

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

Heydenrych

Boulle

Kapoor³

et al. 2021

CCID

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show abstract

“…One cannot hold both positions. 2 Reliance on aspiration requires no movement, yet movement is promoted by many consensus groups as a significant safety procedure. 3-5 Movement of the instrument in and out of vessels is believed to reduce the chance of inadvertently injecting an embolic bolus of filler within a single vessel.…”

Section: Resultsmentioning

confidence: 99%

“…This movement should reduce the chance of a large inadvertent intravascular bolus of filler, thus limiting potential ramifications, especially visual loss. 2 , 3 …”

Section: Resultsmentioning

confidence: 99%

Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice

Goodman

Magnusson

Callan

et al. 2021

Aesthetic Surgery Journal

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Background Aesthetic physicians rely upon certain anecdotal beliefs regarding the safe practice of filler injections. These include a presumed safety advantage of bolus injection after a negative aspiration. Objectives The article aims to review and summarize the published literature on inadvertent intravascular injection of hyaluronic acid and to investigate whether the technique of aspiration confers any safety to the practitioner and the patient. Methods Pertinent literature was analyzed and our understanding of the safety of negative and positive aspiration outlined. Results The available studies demonstrate that aspiration cannot be relied upon and should not be used as a safety measure. It is safer to adopt injection techniques that will avoid injecting an intravascular volume with embolic potential than use an unreliable test to permit a risky injection. Conclusions To prevent intravascular injection, understanding “injection anatomy” and injection plane and techniques such as slow, low-pressure injection are important safety measures. Assurance of safety when delivering a bolus after negative aspiration, does not appear to be borne out by the available literature. If there is any doubt about the sensitivity or reliability of a negative aspiration, then there is no role for its use. Achieving a positive aspiration would just defer the risk to the next injection location where a negative aspiration would then be relied upon.

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“…[24,28] Aspiration, positive or negative, cannot be relied upon as an accurate method of ensuring a safe injection, according to Goodman et al who concluded that one should always assume that one is in a vessel and all other precautions should be taken to prevent a vascular event. [29] However, the author recommends it is advisable while using a needle to aspirate and wait to a count of 10 before starting to inject. Stop the injection in case of a positive aspiration.…”

Section: Advancements In the Facial Approach And Techniquesmentioning

confidence: 99%

Fillers for aesthetics on the face – Newer perspectives

Arora¹

2021

CSDM

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Dermal fillers are a cornerstone of the aesthetic treatments of the face. They have evolved over many aspects since their initial use. Facial fillers are not just used for anti-aging to restore volume, but are now also used for contouring, enhancing facial features, and changing the emotional attributes of the face. Newer techniques and approaches have been proposed for greater predictability of results and minimum complications. Newer composite filler materials and a resurgence of older materials have taken place with better understanding of the science behind them. With more use of facial fillers comes the reporting of newer complications with recommendations and guidelines to avoid them. A new perspective is seen in guidelines for their use in the COVID-19 pandemic. This article is a review of the insight into the latest perspectives of facial fillers for aesthetic indications.

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Neither Positive Nor Negative Aspiration Before Filler Injection Should Be Relied Upon as a Safety Maneuver

Cited by 10 publications

References 7 publications

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice

Fillers for aesthetics on the face – Newer perspectives

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