Aspiration - Know your injector.
You may hear the word aspiration thrown around here and there and not be overly familiar with it, so I thought I would explain why aspiration is an essential part of practice that helps keep you safe.
To give you some background to what aspiration is, it is quite simply the drawing back of a syringe prior to administering the product within a syringe. Dermal filler is the main culprit responsible for the risk of Vascular Occlusions; also known as a VO. This, (incase you aren’t familiar, is when an artery is occluded with dermal filler and the blood supply to this specific area is restricted. This means the tissue surrounding the injected area will not be oxygenated sufficiently and can cause untoward complications - which can lead to necrosis / tissue death)
Although rare, low risk never means no risk. So as dermal filler is a hyaluronic acid gel, with a thick consistency (essential for volume restoration) it is imperative that we do not occlude / block an artery during the process. Stay with me here, let me explain….
So, when anyone has a dermal filler treatment, the ideology is that we inject Hyaluronic Acid gel in to the area via a syringe, this will inevitably add volume to the area being treated. Whilst injecting we (as injectors) have ways of keeping you safe. Firstly is our underpinning knowledge of where the main arteries lie within the face and where the ‘danger areas’ are. Alongside knowing our facial anatomy, research proves that aspirating prior to injecting can help the practitioner know that the needle is not inside an artery.
So in the picture above which has been shared with client consent I have aspirated in a very high risk area (at the alar base of the nasolabial folds) and even though we are trained to inject on to bone in this area, and that is where the needle felt it was, aspirating showed me that I was in fact in an artery. The result is I drew up blood from the main artery whilst pulling back the plunger on the syringe. This isn’t dangerous, this is safe. This stopped the client from having a large bolus of dermal filler injected into an artery which would have led to extreme complications. Even though as an experienced injector I know where the arteries are, everyones individual anatomy will differ slightly on position of arteries or depth. I always aspirate even when I believe I am safe because it is an essential part of good practice and my obligation to help keep you as complication free as possible.
This is why it is essential to know your injectors background and ensure they are a qualified medical professional.
What if I had injected into the artery what would have happened next?
I wouldn’t have known immediately had I not aspirated but generally I would always check capillary refill as I treat - this shows me the blood flow to the area is not being compromised. The client may well have left and developed symptoms such as pain, paleness to the area, blotching of the skin around the area occluded (which can then show as tracking up the face as it follows the anatomic layout of the arteries). If misdiagnosed this could lead to impending tissue death aka necrosis and loss of skin is highly likely at this stage or even blindness too!
Again, having a medical professional who can promptly diagnose complications will be imperative to your safety and positive outcome. In the incident of a confirmed vascular occlusion the next step would be to use Hyaluronidase to dissolve the dermal filler promptly and allow for blood flow to return to the area asap.
Although this sounds a bit scary and may make you reconsider treatments, in the right hands the risks of these complications are significantly reduced. A good practitioner will go through all risks with you prior to treatment so that you can make an informed choice.
I should add - Aspirating isn’t always 100% fail safe though. Research can also show that there are many reasons why aspiration can give false reassurance. Some of the reasons for this are:
Higher viscosity fillers (may take a lot longer to pull in arterial blood than other fillers)
Needle tip may move last minute into an artery even though a negative aspiration was apparent.
Every dermal filler can have differing times on how long to aspirate for, as an example., the filler I was using in the picture above was Teosyal Deep Lines, I got this positive aspiration after just 5 seconds.. however if someone only aspirated for 3 seconds they wouldn't have waited long enough to see the positive aspiration. Ideally It is advised to aspirate for 10 seconds. Some fillers have been proven to take around 30 seconds + for the positive aspiration to show!!
Aspirating incorrectly and not keeping the needle in place.
Priming the syringe before use ( a debate for another day!) this is when the filler is pushed to the needle tip to expel the small amount of air in the syringe, prior to injecting. It can be argued that this can be more difficult to draw back effectively.
These are some examples to demonstrate why some will argue that aspiration isn’t always a safe way of avoiding occlusion. From experience I would say if the practitioner knows the dermal filler well and is very knowledgeable on high risk areas (as well as lower risk) and is able to aspirate for the correct amount of time, this can still increase the chances of getting a positive aspiration in an area that may have been missed.
This is the Nasolabial folds and it was on the left hand side where the corner of the nose meets the cheek junction (Alar base) where the positive aspiration was drawn. As you can see from this clients lovely results, it did not impact upon her final result but it did save her from needing it all dissolved!
Thank you to my lovely client for letting me use the pictures to share and educate on important topics.
I hope you found this of some value, and that it has enabled you to see why it is so important to find the right practitioner before committing to treatments.
Final word
I always say if the price is to good to be true then it probably is. High quality, FDA approved dermal fillers aren’t cheap. Also factor in that your injector will have an extensive medical background and copious amounts of training courses under their belts, this will be factored in to the overall price. You are not paying for just the ml, you are paying for education, safety, quality, experience, and a lot more.
Never budget on your face my lovelies.
Kate - Founder of Majestic Aesthetics xx