Soft tissue augmentation with fillers has become an integral part of the practice of every cosmetologist. The prevalence and popularity of injection correction procedures does not at all exclude the risks of side effects and complications after the introduction of fillers. There are also serious complications, such as vascular embolism, which can lead to skin necrosis and blindness. Exclusively for estet-portal.com Dr. Patrick Tracy on the main causes of complications after filler correction and methods for their elimination.
Patrick Tracy – Chairman of the Irish Association of Cosmetic Physicians and the Irish Regional Office of the British Association of Cosmetic Medicine, who offered practitioners a list of recommendations (the "Dublin protocol") on how to act in conditions where there is a risk of complications from the introduction of a filler in a patient.
Have there been any changes to the Dublin Protocol?
Patrick Tracy – Leading speaker of the international professional forum on volumetric correction Inter Profi Forum 2018, which will be held on March 13 in Kyiv. Event organizer – company INSTITUTE HYALUAL. At the forum, the doctor will make two presentations and a live demo:
- «Age-related anatomical changes in tissues. How to achieve the desired and optimal result with volumetric correction.
- "Complications in working with fillers: frontal and temporal zones".
- Live demo of volumetric correction techniques.
"Yes, there are a few changes to note, but overall the Dublin protocol has remained unchanged. Today, there is ample evidence to suggest that topical nitrates should not be used as they lead to constriction some arteries and may make things worse.In 2011 & ndash; 2013 I suggested to stop using them, but for different reasons."
Inadequate training of practitioners and poor quality of the drug used for volumetric correction – the main causes of complications after the introduction of fillers.
Second: I originally recommended 750 units of hyaluronidase (Hyalase). Many colleagues disagreed with me, believing that 30 or 70 units of the drug is enough. To date, it is customary to inject exactly 750 units of hyaluronidase at a time. In particular, the following is practiced in Europe and Russia: 1500 units of hyaluronidase are mixed with 2 ml of sterile saline or 1 ml of saline + 1 ml of lidocaine. Thus, each 0.1 ml of the solution contains 75 units. hyaluronidase.
Third: a delayed-type reaction, when pain and blanching appear a few days after the procedure, may be the result of vascular compression. Many plastic surgeons claim that it is impossible to compress the facial artery, but compression of the vein can be the cause of the problem. Many now agree with this. Therefore, I consider it appropriate to use steroids that can reduce compression. To do this, boluses of 10 mg of dexamethasone 4 mg / ml are administered for 2 days. But even if the problem is not in the veins, steroids will not cause harm and help to suppress the inflammatory process in case of impending necrosis.
What are the main causes of complications after the introduction of fillers?
Recently, the frequency of complications after the introduction of fillers has increased. In particular, in the UK, this is due to the fact that today pharmacists, paramedics, cosmetologists can perform filler correction – professionals who previously did not have the right to carry out such procedures. They complete courses and, not having proper knowledge in the field of anatomy, start working – this entails a lot of problems.
The second reason is that the above courses teach how to work with cannulas. And many people think that this tool eliminates the risk of complications, although this is not at all the case – of the last 27 cases of lip occlusion that I have encountered, 23 occurred after cannula correction.
Third – this is a huge amount of low-quality products on the market. Of course, this issue should be regulated by law. In Europe, new regulations that will clear the market of most low-quality drugs will come into force in 2020. The new protocol on medical devices will provide for the application of a barcode and a chip on their packaging.
Cannula operation does not exclude the risk of complications after the introduction of fillers.
Also, but this is not yet confirmed information, fillers will be classified as POD – medical products, available only on prescription. Such an innovation will drastically change the market, because in order to use a POD, a specialist must have the appropriate qualifications.
Fourth, we have always suspected that lidocaine may also play a role in the development of post-filler complications. The problem is that manufacturing companies include such substances in their products and are not responsible for the consequences of their use. If it is proven that lidocaine is one of the causes of complications, why add it to the drugs?
Many companies today recommend using 20 ml of filler for aesthetic correction. What do you think about it?
Many years ago I worked with patients with HIV-associated lipodystrophy; then for augmentation of the soft tissues of the face, I used 20 ml of filler. However, the maximum amount of product for a healthy patient – 4 ml, and in most cases, 2 ml of filler is sufficient for aesthetic correction of the face.
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