The most dangerous complications after hyaluronic acid injections and how to avoid them

Any injection procedure is associated with certain risks of side effects and complications. Preparations based on hyaluronic acid, despite the high safety profile of the substance itself, are no exception. However, plastic and aesthetic surgeon Lakhdar Belhaouari (France) is convinced that the practitioner can avoid about 95% of potential complications after injections of hyaluronic acid. How to do this, the doctor told in an interview for estet-portal.com.

Lakhdar Belhauari – plastic and aesthetic surgeon in Toulouse (France). Member of the French Society for Plastic Reconstructive and Aesthetic Surgery and the European Council for Plastic Reconstructive and Aesthetic Surgery. Speaker and teacher of courses in aesthetic surgery and international congresses, author of publications, including the book "The Art of Botulinum Toxin in Aesthetics" and "Report on Aging" for FSPRAS. Paris, France.

What adverse events can Vycross™ fillers avoid?

In Vycross™ short chains of hyaluronic acid are used. And since this approach simplifies the cross-linking process, it allows us to use lower concentrations of hyaluronic acid to achieve a similar effect – this is very important.

Another benefit of Vycross™ (developed by Allergan) is the filler absorbs less water. So, with the introduction of 0.1 ml of any HA product, 0.4 ml of water is absorbed – this figure is lower when using Vycross™ technology. For example, when correcting the nasolacrimal sulcus, such adverse events as the Tyndall effect are unacceptable. Products made using Vycross® technology avoid this phenomenon: for example, with the introduction of 0.1 ml Volbella®; only 0.1 ml of water is absorbed into the nasolacrimal sulcus. Other products absorb significantly more fluid – 0.4 ml. Because Vycross™

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Products made using Vycross™ technology eliminate the risk of the Tyndall effect when correcting a wide range of areas.

Do you use MD Codes?

LB The MD Codes system is very useful as it includes instructions and rules for injection correction for both professionals and beginner aestheticians. Thanks to this system, the specialist can obtain information about the optimal injection points for drugs that provide the best results – and this is very important.

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How often do you perform an aspiration test and why?

LB The practitioner should have a thorough knowledge of anatomy and danger zones. Since there are many anatomical features, such as the location of the vessels, etc., characteristic of individual patients, certain rules must also be observed to avoid complications. In this aspect, aspiration is very important, without which you can never inject the drug.

Thus, in order to avoid complications and adverse events after the introduction of hyaluronic acid, knowledge of anatomy, including dynamic, as well as dangerous zones, is necessary. For example, it is important to understand that the facial artery is connected to the ophthalmic artery via the dorsal nasal artery. Also, do not forget that there are various anatomical features (for example, the absence of the angular artery in 40% of cases).

Always perform an aspiration test, inject the drug slowly, exerting slight pressure on the piston – it should be less than blood pressure. You can use a needle or cannula, but you must always aspirate when using a needle in any area, especially hazardous areas.

Always perform an aspiration test before injection, inject the drug slowly, exerting slight pressure on the piston – it should be less than the blood pressure

What are the most common complications after hyaluronic acid injections?

As for complications after HA administration, 95% of them can be avoided by the doctor if he knows exactly where to inject the drug and has good injection technique. Therefore, continuous learning is critical for the practitioner to know well:

why to carry out injection correction (i.e. patient expectations);
where to inject the drug (i.e. anatomy);
how to inject the drug (i.e. technique);
what drugs to use (such as
• products based on Vycross™technology) and what to avoid.

The above knowledge allows you to avoid 95–98% of complications.

But the most dangerous are vascular complications – tissue necrosis and blindness due to the fact that the facial and ophthalmic arteries are connected through the dorsal nasal artery (terminal branch of the ophthalmic artery).

Using the correct insertion technique and knowledge of anatomy, as well as anatomical variations, can avoid many complications after HA injection.

To avoid 95–98% of complications, knowledge of anatomy, injection technique, the correct choice of the drug and the patient for injection correction will help.

What should be done in case of such complications?

In case of necrosis, apply a warm compress, wait, massage and inject hyaluronidase. The most dangerous complication is blindness caused by embolism of the ophthalmic artery. In this case, the doctor has less than an hour to correct the situation: using a 25-gauge needle, inject 1000 units. hyaluronidase in the orbital region, directly near the ophthalmic artery. The right actions performed in this short time period can completely change the situation in favor of the doctor and, of course, the patient. Therefore, be careful and remember that each specialist must be well versed in anatomy, master the correct injection correction techniques and know the sequence of actions in case of complications.