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

Abstract

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.

Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

“…Delayed HA granulomas have a variety of causes. 1 , 2 , 3 , 4 , 5 , 6 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 24 Anecdotal evidence brought a new concern with the COVID pandemic – the effect of COVID infection or vaccination on the development of granulomas. This retrospective cohort of the senior author’s practice shows that there was a statistical increase in the development of HA granulomas during the COVID pandemic.…”

“…Noninfectious granulomas have been associated with viral illnesses, and vaccinations, including Sars-CoV-2 (COVID). 2 , 10 , 13 , 21 , 22 , 23 These granulomas usually present 3-5 days from the onset of illness. Management of post-illness granulomas are treated with systemic steroids, antibiotics, anti-virals, and hyalauronidase.…”

Delayed adverse reaction to a natural dermal filler mimicking salivary gland neoplasia

“…The global demand for dermal filler placement necessitates a focus on patient safety. The recently updated 10-point plan for procedural safety in soft tissue filler treatments provides treating physicians with methodical strategy for avoiding and managing adverse reaction (Heydenrych et al 2021 ). Patients should be well versed of their responsibility to disclose information of filler placement should a soft tissue reaction develop.…”

Ischemic complications of dermal fillers

“…Given the low incidence of cases, no high-level studies currently exist that allow for a clear management recommendation for this devastating complication [47] . Ocular physical maneuvers, including compression and paracentesis, are a rapid intervention [47,48] . An ocular massage can be performed with manual firm compression to the globe in 10-20 second intervals followed by a sudden release.…”