Filler injections to restore soft tissue volumes, as well as face beautification in general, are today an integral part of the package of services provided by almost every cosmetologist.
There are many drugs and techniques that, if chosen correctly, provide excellent results in both young and old patients.
Christopher Rowland-Payne, Leading Dermatologist of the Kingdom of Great Britain shared with estet-portal.com his vision of an ideal facelift with hyaluronic acid-based fillers, The 1 ml facelift protocol, and also spoke about the most dangerous complications after the introduction of fillers, methods for their prevention and control.
Tell us about your facelift protocol with The 1 ml Facelift
The main goal of The 1 ml Facelift – get the maximum result for the patient, using the minimum amount of filler – 0.5 ml on each side of the face. To do this, it is important to select key injection sites, which may vary from patient to patient. Therefore, it is first necessary to examine the face and determine the areas that require correction in the first place.
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Often the first of these is the area under the wings of the nose – a shadow falls on it, which, as a rule, also passes along the nasolabial fold. If you introduce a small amount of filler into the space behind the wings of the nose (for safety reasons, it is better to carry out the procedure with a cannula), then using 0.05 ml of the drug on each side of the face, you can increase the anterior projection of the nose by several millimeters and remove shadows near the wings and along the nasolabial folds.
Second segment – eyebrow area. By raising the eyebrow just a millimeter, we can increase the amount of light that falls on the orbit of the eye. To do this, a cannula is inserted through a small puncture near the lateral part of the eyebrow and 0.1 ml of HA filler is injected very superficially, into the subdermal layer, in a retrograde technique.
The third key point for most patients – slightly lowered corners of the mouth, which must be raised using the "Mona Lisa" technique; with 0.1 ml of filler on each side.
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The rest of the preparation can in most cases be used to volumize the zygomatic area. In this case, the filler is injected subdermally using the fan technique – this will provide good volume, anterior projection and face lifting, including the lower jaw. Thus, with 0.5 ml of the preparation on each side of the face (only 1 ml of filler), excellent results can be obtained. This procedure can be carried out twice a year.
The main goal of The 1 ml Facelift – get the maximum result for the patient, using the minimum amount of filler – 1 ml (0.5 ml on each side of the face).
How much filler is needed to make up for a larger loss of facial volume
Of course, in such cases it is necessary to use more than 1 ml of – sometimes some patients need to inject 2 and even 3 ml of filler. However, in most cases, patients come to me twice a year for botulinum toxin correction and 1 ml of HA filler in one treatment.
If a new patient comes to me at the age of 45 & ndash;55 years old, I warn you: to restore the face, it will take three procedures a year for three years. This is very important – no overcorrection, which is especially true for patients from Western Europe who do not want to stand out and look like they were injected with fillers. Therefore, gradually, three procedures a year for three years, we return the patient's face to its original appearance.
After that, the number of visits is reduced to two per year (one procedure in five and a half months) – such a correction will maintain the results obtained for about 15 years. I have patients who, 10 years after starting work, look better than at the first visit.
What complications after the introduction of fillers, in your opinion, are the most dangerous
Undoubtedly, the most dangerous complication after the introduction of fillers is the loss of vision – this is a major concern for all professionals who use injectable fillers.
What can cause vision loss after fillers
The abundant blood supply to the face results in rapid healing and minimal scarring after injury or surgery. All vessels of the face are interconnected. But at the same time, such features of the blood supply are dangerous: in the case of a filler injection into any vessel, the drug can migrate, even against the blood flow, and end up in the eye. We are aware of a number of such cases.
Two or three years ago, a paper was published that described 98 cases of vision loss after filler injections. In half of them, the complication developed after the introduction of fat, in a quarter – after hyaluronic acid injections. We can say that the probability of loss of vision after the introduction of the filler in any area of the face is approximately 1:1000000.
What are the ways to prevent vascular complications after the introduction of fillers
It is very important to be careful: if possible, work with a cannula and not with a needle; always aspirate before administering any drug; do not apply strong pressure during injection; the tip of the tool is best kept in motion – this will help reduce the residence time in the affected vessel. It is better to use a retrograde rather than an anterograde filler technique.
Of course, there are exceptions, but in general, the above basic rules will help minimize the risk of vision loss after the introduction of fillers. Particular care must be taken when working in areas of the face with a particularly abundant blood supply. It is important to always take into account the likelihood of developing this complication, be prepared for the worst outcome and quickly neutralize the problem.
Undoubtedly, the most dangerous complication after the introduction of fillers is the loss of vision.
What to do in case of intravascular injection of the filler
First, it is important to remember to prevent complications.
Secondly, it is necessary to develop an action plan and make sure that all the drugs necessary for its implementation are available, as well as inform the staff. It is equally important to diagnose the complication in a timely manner and take all necessary measures.
First – inject hyaluronidase (in the case of HA fillers, which are used most often). Hyaluronidase, which dissolves the filler, in the event of a complication in the eye area, is injected by cannula through the supratrochlear arch and, possibly, retrobulbar.
To avoid vasoconstriction due to stress, the patient should take diazepam.
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After that, they proceed to actions aimed at dilating blood vessels. This promotes the movement of the embolus into smaller vessels, where the consequences of the lesion will be less serious. This effect will provide alcohol, heat and tapping with your fingers on the problem area. Smoking and cold, which provoke vasoconstriction, must be avoided. You can also use drugs such as glyceryl trinitrate spray, oxpentifylline, sildenafil, nifedipine. In this situation, it may be appropriate to use all of these vasodilators, after which it is necessary to re-inject hyaluronidase into the affected area. Oxygen must also be available.
The above measures should be taken in case of ischemic complications after the introduction of a filler based on hyaluronic acid. If the complication is localized in the eye area, rapid breathing and palpation of the eye will also help, which will reduce intraocular pressure due to the expansion of blood vessels. It is important to take the above measures quickly, because all these drugs should always be at hand.
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