today I'm discussing two of the most talked-about complications from dermal
fillers hi guys welcome back to the channel thank you so much for joining me
once more just to let you guys know the format is going to be changing over the
next month or so while we have a slight hiatus between patient shoots but
needless to say in four weeks we will be back bigger than ever and with a
surprising new intro so for the next four weeks I'm going to be talking about
some well hotly debated topics and the first one of those is going to be
discussing two of the things which come up again and again during consultations
so can you guess which two complications regarding dermal fillers people mention
over and over and over again go out and have a guess you will probably not guess
although actually you might do if you are somebody who has dermal fillers so
the first one is bruising the second one is blindness which is weird because
they're completely the opposite ends of the spectrum in terms of likelihood to
happen so often a typical term will fill a consultation will go something like
this
could you just like not bruise me okay so I understand that you don't want to
bruise however I do have to let you know that it is a risk whenever we do these
injections that you might get a bruise your the thing is no I really just I I
just like can't have a bruise right now you know I've got like I've got to take
my dog to the vets and he's very picky don't want to distress my dog you know
right this is probably not the best time for you to be having your dermal fillers
done then because as you know the face is quite vascular and there is a chance
that you could get a bruise from of these injections oh you know what
it's fine it's fine he's seen me with a bruise before poor little pinky can just
deal with it let's just go ahead okay okay if you're happy with that and you
don't have too much arm over the next week or so then that's fine let's go
ahead so as you can see there are a lot of blood vessels underneath the skin and
it's kind of more amazing that we managed not to bruise people I think so
if you do have an event or something like that coming up just don't have an
injection done please it's not worth it wait until after your event or plan to
have something way before your event then pull if you do get a bruise and you
wanted to go more quickly you could try maybe laser IPL there are certain light
settings which will help to break down the pigment more quickly you can also
try taking some bromelain though it's a little bit of evidence for arnica
although not as much as there is for bromelain other things like mg bruise
formulation can help too but the reality is you just gotta suck it up sometimes
the next thing that people ask me about is blindness which is totally at the
opposite end of the spectrum to getting a bruise so what are the risks of
someone being blinded as a result of a dermal filler injection to date there
have been under 100 cases of people who have been blinded as a result of having
a dermal filler injection when you put that into context it's really not a very
large number asshole in comparison to the number of people globally who
receive said injections last year in America there were over two million
dermal filler injections and according to the Economist your chances of dying
in a plane crash r1 in 5.1 million so actually you
probably have more chance of dying in a plane crash than you do from becoming
blind as a result of dermal filler injections in 2016
according to parliament UK there were 180 1384 accident casualties recorded on
Britain's roads with 1792 of those proving to sadly be fatal again I'm just
gonna put this blindness then into context for you and less than a hundred
cases have been reported with hyaluronic acid globally so it is a very very small
number of people obviously you could argue well you're making an intervention
there and you know it's not something which is strictly necessary to do but
I'm just trying to give you an idea of how likely is that something like that
would happen and yes that our probably cases which
are unreported perhaps in other countries but nevertheless that's the
lie of the land so far and the reason why I'm emphasizing this to you is
because for some reason over the past few months I've seen a lot of people be
really really worried about this complication you know they come in they
want to have a procedure done and they're really just tying themselves up
in knots here you know they don't know whether or not they should go for it or
not and there's a real sense of panic so I guess what I'm saying is really don't
panic in terms of numbers the percentages are the glabella which is
this area here a thirty eight point eight percent of cases were from the
glabella so that is the highest risk area the second highest risk area is the
nose area at twenty five point five then the nasolabial fold at thirteen point
three which is ironic because that's often the area that people tend to
inject first of all and they're learning how to inject and then the forehead at
twelve point two hyaluronic acid accounted
for 23.5% of those overall cases the rest of the making up with fat Polio
lactic acid calcium hydroxyapatite other bizarre things that people choose to
eject in their face like paraffin for example nevertheless blindness has been
shown to occur anywhere on the face that you choose to eject but let's just think
about those numbers again guys so it's very very unlikely to happen people have
started asking me how do you mitigate against some risk of blindness and I
think this is quite an important question to answer because there's
obviously an appetite for people to know so the first is knowing the vessel
location and depth so this is the biggest argument thus for for seeing a
doctor who is experienced with facial anatomy and all the doctors who work
with me right now have both medicine and dental degrees and they are experienced
in maxillofacial surgery so you really couldn't pick a better bunch of people
vessel depth varies according to the anatomical location so remember that map
that I showed you before you know with all the blood vessels on this one right
here the big vessels which are these
our often in reproducible locations not always so for example the facial artery
which you have coming up right here is normally got one of four different
anatomical variations so you really you kind of need to know what all the four
different anatomical variations are if you're going to be injecting this area
safely so anatomical knowledge is the number one thing which is going to keep
you safe from other complications such as necrosis the second suggestion is to
inject slowly and with minimal pressure not just you know BAM everything in
there as quickly as you can the third is to inject very small
amounts each time and doing less than 0.1 mils per injection point some people
say it's better to move the needle tip when one is injecting because then
you're less likely to be inside a vessel when doing so and this really varies
country to country so in Australia for example a lot of colleagues over there
will tend to move the needle tip whereas here it's not really a thing another
thing is aspiration and this is actually quite controversial so you'll see
parotid across quite a lot of the forms I'll make sure they aspirate it kind of
depends on what you're using to aspirate with and the size of your needle so
there have been I think three different papers published showing which products
can be aspirated and also which diameter of needle can be aspirated with
according to each product because it's different with each one and also how
long it takes to get a positive aspirate so in clinical practice is when we're
aspirating you'll often do it for maybe a second or two before injecting whereas
with some products you actually need to aspirate for maybe four seconds maybe
six seconds before getting a positive aspirate and in some you actually can't
get a positive aspirate at all it's impossible so it's kind of a funny thing
there are some areas that I will aspirate an injection such as the base
of the nose the temple for example however when
treating the lip in the Vermilion border I do not tend to aspirate at all when
I'm using a cannula again I don't aspirate in most areas it's also
recommended to use a small diameter needle and when you're injecting you
inject on top of the bone well not everywhere but in a lot of places that's
the safest place to inject consider using a cannula which is a small blunt
ended needle because with that you're unlikely to be able to pierce a blood
vessel however it has been known that vessels can be cannulated so for example
when treating the nose there have been studies where the these
little vessels here have been cannulated by people injecting upwards like this
and it's been placed up the length of the vessel so when using a cannula it's
kind of smart to go across where you would expect the blood vessel to be for
example in the glabella area instead of injecting along the pathway of the
vessel you would inject lateral like this be careful in patients who have got
previous surgery in the area so for example if they have got a facelift or a
previous rhinoplasty and things often aren't exactly where you would expect
them to be because they've been moved during surgery and also there's quite a
lot of fibrotic tissue there being able to manage a complication is also
important now there have been now there has been one case of a person who has
had their sight restored after blindness from a dermal filler injection and that
person received some retrobulbar injections of holidays which is where
it's passed all the way along the orbital floor and deposited at the back
of the eye and also there are two little holes here in here that were flooded
with the hyalase as well but that's that's the only one as far as I'm aware
they do say that you can also use digital pressure along the nose or along
the orbital rim while injecting these areas to try and prevent any filler
being forced along the blood vessel someone asked me recently well what you
do if it happens to me very unlikely I said
but okay this is what we would do so you have to reduce the intraocular pressure
by rebreathing in a paper bag which increases the
amount of co2 in the blood which causes video dilation use aspirin massage the
eye so you press quite firmly on the globe for a second or two then release
and you repeatedly do this it has been shown that this can dislodge sometimes
filler particles in the in the arteries at the back of the eye so that the sight
is restored and then the last thing is to use holidays but really you want to
be going across to an eye hospital pretty pretty quickly straight away
essentially so people often ask how is it possible that you can have a lip
injection and become blinded well this is the answer here so you can imagine
you've injected there and this is going against the flow of blood that is what
will happen and it can also happen in the base same principle injections in
the nose injections in the nose forehead injections even injections along the
zygomatic arch here like so like I said it's super unlikely to happen but that's
the mechanism the second diagram that I wanted to include is this one because
well it just shows you the vessel going into the back of the eye here and I just
thought it was kind of cute and funny that they like just drew this themselves
for a scientific journal anyway this is another schematic of how it can happen
that you have an injection somewhere downstream so to speak say here or say I
don't know somewhere and you become blind
that's how it works just the more blindness facts for you so top three
causes of blindness cataracts glaucoma and macular degeneration again just for
some context so 2.3 million Americans have glaucoma and an additional 2
million have glaucoma and don't know about it so again just to help you with
those numbers there which are incredibly small and then we've got an additional
22 million Americans with cataracts and those figures are according to the
National Institute of something National Institutes of Health there we are
very serious stuff ok so that's all we have time for this week if you have any
questions comment let me know in the down section below I'll be back next
week discussing something with a bit more
levity so I look forward to seeing you then don't forget to subscribe to the
channel see you later