On March 13, Kyiv hosted the International Professional Forum on Injectable Volumetric Correction Inter Profi Forum, organized by Institute Hyalual. One of the leading speakers of the event – world renowned Dr. Patrick Tracy – told how to achieve the desired and optimal result with volumetric correction, and also revealed the topic of complications in the frontal and temporal zones when working with fillers. Dr. Tracy shared his views on these critical issues with estet-portal.com.
Patrick Tracy (Ireland) – plastic surgeon, President of the Royal Council of Aesthetic Medicine 2017. Chairman of the Irish and British Association of Injectable Cosmetologists. Recognized as one of the most influential estheticians in the European aesthetic cosmetology community.
What should I do if the doctor and the patient see the final result of the correction differently?
This doesn't happen very often. In particular, this situation may arise when working with patients suffering from a mental disorder such as dysmorphophobia. Their percentage in the practice of a doctor is about 10%.
I believe that if a patient is too fond of aesthetic procedures, the doctor is responsible for him and therefore should limit their number, trying not to suggest additional procedures.
In most cases, the doctor and the patient agree on the end result. But sometimes patients' expectations are too high. For example, my colleague mentioned cases of treatment of patients with significant excess weight, who asked to make them a figure like Kylie Jenner. Of course, in such situations, the doctor answers that this is impossible.
The doctor must take responsibility and not cross the ethical line by agreeing to undergo a procedure whose outcome would be inappropriate or unacceptable.
The doctor must take responsibility and not cross the ethical line by agreeing to undergo a procedure whose outcome would be inappropriate or unacceptable.
What do you think is the optimal results of volumetric correction?
For me, this is the restoration of facial symmetry. It is worth noting that often the best result is invisible to others. I think that high-quality aesthetic work should not be conspicuous, stand out on the patient's face.
Good estheticians can be compared to painters or sculptors: they are also often left-handed and work according to the symmetry dictated by the golden ratio and their own mind. Some people can draw, others – no. Here we can draw an analogy with the training of correction with botulinum toxin or fillers by numbers: it allows people who do not have talent to improve their skills a little, but talented specialists still do a lot of things their own way.
Unfortunately, many companies are trying to fill the market of aesthetic medicine with a large number of people, teaching them how to improve their appearance. This causes everyone to start looking the same.
Therefore, the optimal result of volumetric correction – when the patient looks good, but neither overcorrection nor any asymmetry catches the eye.
Often the best result is invisible to others: when the patient looks good, but neither overcorrection nor any asymmetry catches the eye.
What are the most common complications after fillers?
Fortunately, the most dangerous complications after fillers occur the least frequently. As for the most common complications, they include bruising and swelling. Such complications can be minimized by working with high-quality fillers. And refusal to take aspirin, vitamin E, alcohol, fish oil a week before the procedure can reduce the risk of bruising.
Another problem – delayed (about 3 months after the procedure) appearance of nodules and seals on the face.
Biofilms (a collection of closely packed micro-organisms) are next in frequency.
Even less common is vascular occlusion, which is obviously the most dangerous complication, and can lead to blindness. I have personally dealt with two cases of blindness treatment in the last 12 months. One such case occurred in Sweden, and the second – in California.
What should the doctor do if a complication develops after the injection of the filler?
It all depends on the type of complication and the filler used. In case of vessel occlusion after the introduction of a HA-based filler, the first thing to do is – massage the affected area, heat it to provoke the movement of the embolus, and then quickly inject a large dose of hyaluronidase (Hyalase). Most early complications can be resolved fairly quickly if acted promptly. For the last six years, I recommend using 750 units. hyaluronidase. And fortunately, my colleagues also increased the dosage of this substance from 75 to 750 units, which is very good.
After that, you can use other – try to stimulate vasodilation with nitrates. We now use oral nitrates like Viagra or Cialis instead of topical nitrates, which lead to paradoxical problems – increase in emboli due to vasodilation in the treated area.
As for the most common complications, they include bruising and swelling; nodes appear less often and biofilms form. The most dangerous and rare complication – vascular occlusion, which can lead to blindness.
The use of hyperbaric oxygen remains a controversial issue in many respects. However, I use this method quite widely. In 40 of the 72 cases of vascular complications that I have encountered in the last 2.5 years, I have used pressurized oxygen, and it worked well. Some scientific studies on necrosis of facial tissues, bones, avascular necrosis, indicate the absence of a direct effect of hyperbaric oxygen, but I see it – I have used hyperbaric oxygen therapy 3 times in the last week.
Share your impressions of today's event
I always enjoy visiting Ukraine. I believe that there is an incredible thirst for knowledge in the field of aesthetic medicine in our time. This can be judged by the number of doctors present today at the Inter Profi Forum event organized by INSTITUTE HYALUAL. It's great that everyone follows international protocols. It would be great if doctors from all over the world could pool their resources. And such congresses, such as in Monaco, Paris and now in Kyiv – a great way to achieve this goal.
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