How to safely use a BD syringe for dermal filler treatments

When Dr Tim Pearce performs demonstration dermal filler treatments for non-surgical or liquid rhinoplasty, lip definition, or tear trough treatments, his audience often asks why he uses a BD syringe instead of the supplied syringe for the dermal filler product.

In this blog, Dr Tim explains the reasons why he chooses to use a BD syringe when treating certain areas of the face including the implications for safety, precision, and extrusion pressure. He guides aesthetic clinicians on how to do this safely, whilst also touching on why this technique is not appropriate for all global aesthetic practitioners where regulations are stricter, like in Australia. He also speaks to Sydney-based Dr Jake Sloane, one of Australia’s leading aesthetic doctors and cost-host of the Inside Aesthetics podcast for more insight.

Why does Dr Tim use BD syringes for some dermal filler treatments?

Because he does not usually use the full 1ml of product contained in the original syringe, Dr Tim regularly uses a BD syringe when treating noses. If you are carrying out an adjustment or small treatment to the patient’s nose, you can use a small amount of the product in a BD syringe. It gives you greater control when injecting which is the primary difference between the two devices because the amount of movement of the plunger in a BD syringe is much more for the smaller volume.

When treating the nose, it is preferable to use a ‘little and often’ approach with very small injections coupled with regular capillary refill checks to avoid concerns related to vascular occlusion and blindness. To cause a problem, you would need to inject at least 0.085mls to potentially fill a vessel all the way back to the eye. Therefore, the easiest way to reduce this risk is to only inject 0.05ml at a time, and the best way to control this is by using a device that has increased gradients and makes it much clearer to see how much you are injecting. The difference between the gradients on a normal 1ml supplied dermal filler syringe and the thinner BD insulin syringe is approximately twice as much movement required on the BD plunger to put the same amount of product into the skin, allowing for much more accurate delivery.

Does a BD syringe affect the result of filler treatments?

Dr Tim does not believe that the use of a BD syringe alters the result as such, but it provides the clinician with more certainty and accuracy when injecting, allowing you a clearer view of how much filler product you are injecting, ergo, it could improve your result.

One of the problems with the dermal filler syringes supplied is their size. When treating, you are often looking at the device from different angles which can make it more difficult to see how much movement is required in the plunger to extrude a small amount of product. With a BD syringe, it is smaller and thinner, and there is less plastic to obscure your viewpoint, making it much easier to see the plunger along the wall of the syringe, from multiple angles, making it ideal for treatment that requires small-volume delivery like tear trough, noses, and smaller details around the mouth and lips.

The use of BD syringes is not appropriate when treating all facial areas, however, particularly where you do not need much discernment between different volumes because it is safe to be within a 10% margin of error when you are injecting larger amounts in areas that are less sensitive to tiny differences in product volume.

Does using a BD syringe affect the risk of causing vascular occlusion?

One of the reasons why Dr Tim uses BD syringes when treating the nose and tear troughs is to reduce the severity of any vascular occlusion that may occur, despite other risk mitigators. This technique does not necessarily reduce the frequency rate of this complication, but it will make the outcome (the blockage) much smaller and more manageable if it happens.

Does using a BD syringe affect the extrusion force required for the dermal filler product?

Some aesthetic clinicians discover that one of the downsides of using a BD syringe for filler treatment is the compression or extrusion force required to inject, which can be much higher, particularly with thicker dermal filler products.

This is due to the changing physics within the syringe, the amount of movement required on the plunger for a thicker product means that you will need to push harder and for longer. Therefore, you might choose to reserve the use of this technique with BD syringes for lower-viscosity products or start doing thumb exercises to increase your strength and ability to apply the required pressure.

What are the downsides of using a BD syringe for dermal filler treatments?

We must consider whether there might be something in BD syringes that could negatively affect the filler product; however, Dr Tim does not believe that there is clear evidence to suggest or support a problem. There are theories abound that silicon oils used on the inside of BD syringes, which may also be present on the inside of the syringes used in filler product manufacture can trigger inflammatory responses.

An interesting study published by Dr Maria Landau et al noted morphea-like lesions potentially caused by silicon oils inside BD syringes used to inject botulinum toxins. This phenomenon, considered very rare, results in small indentations in the skin after injection. Dr Tim notes that he has only seen one case in his career, but it therefore does pose a potential risk with BD syringes for dermal filler treatments. He has yet to find a patient that he can identify as a reactor to dermal filler after using a BD syringe for the injection, but there is a theoretical risk that you may want to consider when deciding whether to use this technique. Dr Tim does not regard it as high risk, however, and he continues to use BD syringes for certain dermal filler treatments.

For more on this, read Dr Tim’s blog on how to avoid Morphea-like lesions – a BD syringe issue that explores the findings from the clinical paper by Dr Maria Landau et al.

Can the technique of using BD syringes for dermal filler treatments be used globally or do regulations differ?

Dr Jake Sloane originated in the UK but now lives and works in Australia. With many of Dr Tim’s audience coming from around the world, he asked Dr Jake to provide additional insight into the regulatory differences that affect aesthetic clinicians in different countries.

Having worked as a cosmetic doctor in both the UK and Australia, Dr Jack explained that it is abundantly clear that there are different regulatory expectations and guidelines to adhere to in the southern hemisphere. Traditionally, regulation in the UK is viewed as lacking, whilst in Australia, things have recently been tightened yet further with new regulations coming into effect on 1^st July 2023.

Referring to the use of BD syringes for dermal filler treatments, he noted that this does not need to be country-specific when one is assessing its merits. This is a clinical decision and boils down to some simple facts. If you have a pre-filled syringe of dermal filler with a supplied needle or cannula from A. N. Other pharmaceutical company and you change the parameters by using your own needle, your own syringe, and potentially cause an issue of sterility or no sterility during the decanting process, then it is logical to argue that this is not how it was designed to be done.

In Australia, each aesthetic injector is either a cosmetic doctor or a registered nurse. There are nurse practitioners who are a little bit more autonomous and can prescribe for themselves, like doctors, but registered nurses must work under the supervision of a prescriber. Therefore, if a registered nurse decided to go “off-piste” with a technique like this, it would have to be discussed with the prescriber because the prescriber’s job is to consult the patient, come up with a treatment plan, and then delegate the treatment to the nurse. Hence, if the prescriber does not deem it an appropriate technique, for the reasons mentioned above, then the nurse cannot perform it, confirmed Dr Jake.

Read more guidance from Dr Tim in Injection Techniques 101: Good Injection Techniques for Dermal Fillers and download Dermal Filler Complications: The Essential Guide for 2023. Dr Tim covers a range of complications that can arise from medical aesthetic treatments and discusses lesions and bruising as well as serious complications like vascular occlusion and blindness. The updated guide for 2023 also includes a bonus case study on necrosis.

You can follow Dr Jake Sloan on Instagram and learn more about his Inside Aesthetics Podcast which he co-hosts alongside aesthetic business coach David Segal. Dr Tim is always keen to hear about the experiences of his followers. So, if you have any tips for others or questions for him, you can find Dr Tim Pearce on Instagram.

Aesthetics Mastery Show

How to safely use a BD syringe for dermal filler

Dr Tim introduces the episode saying:

“I always get questions about why I’m using a BD syringe in noses and tear troughs instead of the device that comes with the dermal filler product? There are lots of reasons, including increased safety, precision and pressure. In this video I explain how and why I use a BD syringe in these areas, plus share a conversation we had with Dr Jake Sloane, an injector living in Australia to weigh in on whether using this trick will void insurance.”

Watch the full Aesthetics Mastery Show here.

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Dermal Filler eLearning Courses

If you want to increase your knowledge about safe and effective dermal filler injectable treatments, Dr Tim Pearce offers a series of fabulous courses. The foundation level is a popular starting point, with many delegates continuing to complications courses focused around safety, including how to minimise the risk and how to handle things if the worst occurs:

• Dermal Fillers Foundation Course
• Dermal Filler Complications Mastery

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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.

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