When you inject dermal fillers into the face – ie Juvederm, Restylane, Voluma, Kysse, Sculptra- any of them, you frequently use a needle to inject. One of the biggest complications we discuss at meetings is injection of filler into a blood vessel. I have not had this happen, but if it does, it can be devastating. Tissue loss, dead skin, blindness. (!)
So how do you avoid it? One of the techniques discussed to avoid this issue is to pull back on the syringe, called “aspiration,” and make sure you don’t see a flash of blood. The thought was if the needle is in a blood vessel when you do that you will see a flash of red. That means do not inject, because you are in a vessel.
This study refutes that technique.
“Aspiration Before Tissue Filler- An Exercise in Futility and Unsafe Practice.”
Wowsa. This is a study out of Australia in the January 2022 issue of Aesthetic Surgery Journal. It starts, “Aesthetic physicians rely on certain anecdotal beliefs regarding the safe practice of filler injections.” For their study they looked at literature and current understanding.
What did they conclude?
“The available studies demonstrate that aspiration cannot be relied on and should not be employed as a safety measure.” They showed studies which looked at a “quick pull of plunger” to aspirate, a “slow pull test on plunger” “No moving after aspiration” “cannula are safer.” None of these were conclusive to help, and they warn of “false negatives” – where you feel like it was okay, when it wasn’t.
So what do they advocate?
- Understanding “injection anatomy” and injection plane and techniques. * This is hard, as even if you understand anatomy, people differ greatly.
- Certain areas are higher risk: glabella, forehead, and nose.
- Slow low-pressure injection
- Continuous movement when injecting
- Low force
- A cannula 27 gauge or less behave much like needles
- It is unrealistic that you do not move a little after your pull back on the plunger, so again, false negative.
- Deep injections on bone are safer in the mid face and temple
- Small injection amounts (less than .04cc)
- Smaller bore needles have less bevel length