3D Injecting – Layering Up Risk Avoidance to Reduce Complications
Steps to reduce your probability of causing an aesthetic complication
from Aesthetics Expert, Dr Tim Pearce
As aesthetic practitioners, the one thing we want to avoid, at all costs, is causing a complication; yet it is important to realise that they will happen. The best way to prevent complications is to employ a ‘probabilistic’ approach which allows you to use incremental steps towards feeling safer as an injector.
Dr Tim Pearce wants to help you to understand the factors which can make a difference to the probable risk of a procedure. He shares simple actions that you can take, such as aspirating, having a good understanding of facial anatomy, choosing appropriate filler products, and using best practice injection techniques. Learning to perform aesthetic procedures by adding in multiple checks along the way will help you to build up the safety profile of the procedure that you are about to perform.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better practitioner, then step one is to register for the free webinars by Dr Tim
Step 1: Should I aspirate dermal fillers?
This is a debate which rages on and on with many arguments for, but also against the practice:
- “You only get a positive flashback because it’s a haematoma.” – The theory is that the combined act of injecting and aspirating is causing a trauma, thus producing a false positive aspiration result.
- “Aspirating doesn’t work because many fillers don’t allow product back up the syringe.” – Different fillers have a different probability of giving a positive aspiration. Take a look at Dr Tim’s aspiration experiment test results to see how quickly different filler brands aspirate.
Many people are put off aspirating as they find it fiddly. Clinicians should practice the technique and improve their dexterity so they can perform it smoothly. To decide whether to aspirate or not, we can turn to probability – can performing aspiration prior to injection go some way towards reducing the probability of a complication, despite not eliminating the risk completely?
Aspirating is not a 100% effective tool. However, that does not mean that we should dismiss it, as there is a chance that it could provide a result which avoids causing a vascular occlusion. A Dutch study on the sensitivity of aspiration as a safety test before injection of soft tissue fillers noted that aspirating ‘works’, to give true-positive results, 33% of the time; that sounds like good odds for doing something as part of a layered approach to risk mitigation.
Step 2: Which filler product should I choose?
There is an argument that the thicker a filler product, the more difficult it is to dissolve. Thus, it is more difficult to resolve a complication with a thicker or more viscous filler, but is it? It is also true that lower viscosity could impact on the probability of causing a complication, because a product which is thinner can flow more easily and quickly into a vessel (see Hagen-Poiseuille law).
When choosing your filler products, it is worth considering the frequency of a problem versus the severity of a problem. You may be able to reduce the frequency of a problem through a product choice which improves aspiration success, for example. However, if you use a low viscosity product, hoping for improved reassurance from aspiration and that proves inaccurate, you may confidently inject, and the flow of the thinner product will go on to cause a more severe problem. The same could happen when using cannulas instead of needles – you reduce the frequency of causing a complication due to the blunt tip, but over confidence that you are not within a vessel, and therefore do not need to aspirate, can lead to more severe complications.
Dr Tim’s Tips will help you answer the question – what dermal fillers should you choose?
Step 3: What are the best injection techniques?
Your choice of injection technique can affect the probability of injury. It is important to understand the impact of factors such as the depth of injection and needle angle on the risk of compromising proximal anatomy. Learn more about the best injection techniques with Dr Tim in the Aesthetic Mastery Show.
As you improve your skills, you can learn the outcome of injecting within a particular area and how that outcome would change if you altered the angle or depth of your injection – both in terms of increasing or decreasing your chances of causing a problem, and the efficacy of your treatment. This will help you to understand the probability of complication risk and how to mitigate it in specified areas.
Dr Tim concludes that to avoid complications when delivering cosmetic injectables you need to chip away at the risk by weighing up all the different parameters which can impact on your chances of causing an injury.
Think of it this way, we wear a seatbelt every time that we get into a car because one day it will save our lives, but chances are, we will not need it every day. The same can be said with practices we employ when delivering injectables, such as aspirating, you do these things because one day it may save you from causing a significant complication.
Aesthetics Mastery Show
This article was created following the Aesthetics Mastery Show 3D INJECTING: How to reduce complications by LAYERING-UP risk avoidance.
Still anxious about delivering cosmetic injectables safely?
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Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
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