The topic of complications is certainly relevant everywhere, especially in the context of the modern expansion of the range of specialists who can use injection techniques in their practice.
In the article estet-portal.com you can learn in detail the tactics of action in case of complications after the introduction of the filler, learn how to choose a quality filler and recognize the formidable symptoms of serious complications of the introduction of fillers based on hyaluronic acid on behalf of the plastic surgeon acting President of ISAPS, who was trained by "father" of Aesthetic Surgery by Dr. Io Pittanga, Dirk Richter, Professor of Plastic Surgery at the University of Bonn, Germany.
What are the main causes of complications when working with fillers
DR: The main cause of complications with fillers is the filler itself, because you're using a filler that isn't well researched, for example, we've seen a lot of problems after using Novabel; a few years ago, this was the most dramatic complication I have ever seen.
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So the product can be problematic, and I'm not aware of a non-absorbable filler that doesn't cause any problems. So hyaluronic acid is indeed safe, but it can still cause some problems because it can encapsulate, become infected, migrate, and cause an allergic reaction. And if you use a hyaluronic filler on a patient with Graves' disease (Basedow's disease, diffuse toxic goiter), he may have problems with exophthalmos. These are important factors that you should take into account.
Secondly, a common complication that we have observed after using the filler is infection. Therefore, if you do not use the filler correctly, namely, if you do not know the correct technique, if you do not observe the sterility of the conditions, you may run into big problems.
Life-threatening complications after filler application
DR: We have seen several life-threatening complications in the aspect of infection near orbit. If an area that is close to a vein that goes to the brain is infected, then microorganisms enter the brain, which can be incredibly life-threatening.
Also in our department, where we focus on complications, we see a lot of consequences in the form of skin necrosis due to incorrect injection into the vessel. The most dangerous area in this regard: the forehead and lips.
The second phenomenon we observed — it is blindness. This is an extremely rare complication, but in the past it has been more frequently described in the literature because the use of fillers is becoming more available and some of the people who provide these services are not familiar with anatomy and they don't know about the things mentioned above.
And another life-threatening situation we've seen is infection of the entire face after a filler injection. The case was complicated by the type of pathogen, it was methicillin-resistant Staphylococcus aureus. And if your patient has such an infection, it is almost impossible to cure it. I really recommend to be careful with the choice and application of the filler.
What to do in case of complications after cosmetic procedures
Your personal rules for choosing filler
DR: I would never go for a permanent non-absorbable filler because it always encapsulates. I have never seen a filler that stays permanently in the fabric and doesn't cause any problems.
I have always chosen hyaluronic acid from a good company that I trust. This is very important because there are a lot of fake products out there nowadays. I wouldn't buy it online because of the low price. I always go directly to the seller to get a quality product.
Doctor's tactics in the event of a complication: personal recommendations
JR: If you are injecting and immediately notice blanching of the skin or lips, then you should immediately jump into Plan B, which you should have prepared for such an eventuality. You must know what to do immediately: for example, inject hyaluronidase into the area where the filler was injected, as well as into the area around this area.
You must have a strict protocol: if blindness occurs, then you should give an intravenous infusion and apply steroids. In some cases, you need a surgical revision. You should also decide whether to work on your own or refer the patient to a center. You must have a contract or a good relationship with such a center in order to take the next therapeutic step and seek help from a specialist who knows how to do it.
Protocols for dealing with complications are published in the PRS (Record and Result Recording System) and on our ISAPS (American Society for Aesthetic Plastic Surgery) Patient Safety website.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Experts" section. You may be interested in: Working on mistakes: complications of contouring
What are the main causes of complications of contour plastics
The main risings for the filler complications are the filler itself because you are using the filler that has no been researched enough, for example we saw many problems after the using “Novabel” a few years ago, there was the most dramatic complication we have ever saw. So the filler itself can be problematic and I do not know about nonresorbable filler that is not causing any problems. So the hyaluronic acid is very-very safe but it is still can cause some problems because it may encapsulate, get infected, migrate, it may cause allergic reaction. And if you use the hyaluronic filler on the patient with the Graves' disease it may become some problems with protruding eyes. This is something that you should take into considerations.
The secondly, frequent complications we saw with fillers is infection, so if you do not use it in the right way, if you do not use the right technique, if you do not provide the sterile conditions, you may get into a big problems.
What are the main life-threatening complications after applying the filler
We saw several life threatening complications in terms of eye infection near to the orbit. If the filler gets infected in this area were the venue going into the brain. And if the germs get into the brain, it can be life threatening. So this is one very dangerous problem. Also in our unit were we concentrate on complications we see a lot of problems with skin necrosis due to wrong injection into a vassel. So the most dangerous area is foreheat and the lips. And the second one is blindness.
This is a rare condition but it has been described in a literature more often in the past before because more and more people are using fillers and they are not trained about the anatomy, and they do not know about things that are below.
And another life threatening thing that we saw is an infection of all face after the filler injection. And there was a problematic germs — Methicillin-resistant Staphylococcus aureus. And if you get the infection like that it is almost impossible to cure it. I really recommend to be careful with the selection and application of the filler.
What are your personal rules when choosing a filler
I would never go for the permanent filler because it will always encapsulate. I have never seen the filler that will stay forever and will not cause any problem. I would always go for the hyaluronic acid from a good company that you trust. It is very important, because nowadays there are a lot of produces that are fake. I would not buy it through the internet because it is cheap. I would always go for the seller himself and odder there to get the right product.
What is the doctor's tactic in case of complications
If you inject and you see immediately that there is a blanching of the skin or something is going wrong, you see the white lip or skin you have to have a protocol of "plan B". You need to know what to do immediately, for example inject hyaluronidase in the area, where the filler have been injected and also in the area around this region.
Than you should have a strict protocol: if you have blindness you should to make intravenous infusion and apply steroids. In some cases you need some surgical revision. Also you should make a decision about independent work or referring to the patient to the center. You should have a contract or good relationship with such a center to make a next therapeutic step and to apply help from a specialist who knows how to dill with it.
Those protocols are published in PRS (Protocol Registration and Results System) and it is also on our website for patient safety on ISAPS (American Society for Aesthetic Plastic Surgery).
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