We know every cosmetic treatment available has its own set of risks. Even if they’re nominal, they still exist. Even with a simple syringe of filler, there are some serious complications that while extremely rare, can still occur. One such risk is vascular occlusion which can lead to necrosis, or tissue death, scarring and, even more seriously, blindness.
Vascular occlusion occurs when filler is injected into an artery and one popular safety measure that some injectors use is pre-injection aspiration, or the act of pulling back of the plunger of a syringe for a few seconds prior to injection. Those who use aspiration before injecting believe it will signal if a blood vessel has accidentally been punctured, but the practice is a controversial topic amongst expert injectors. Other experts say there is no evidence that this procedure is essential or even beneficial, thereby giving the injector and patient a false sense of security.
Researchers of a recent study published in the Aesthetic Surgery Journal performed a review of previously published studies and literature on the practice to analyze, compare and synthesize existing data and evidence. Their conclusion: aspiration before injection does not guarantee safety.
“The Aesthetic Surgery Journal, which is a multi-specialty plastic surgery journal, published this study that was felt to be critically important to those who provide filler injection,” says Chicago plastic surgeon Julius Few, MD. “The real takeaway is that ultrasound studies have shown that this technique of aspiration before injection, which has been endorsed in the past, doesn’t effectively prove safety.”
The reliability factor is the primary issue, notes Eugene, OR plastic surgeon Mark Jewell, MD: “The practice of aspiration before injection does not give the individual injecting the tissue filler useful information about the location of the syringe needle. The ultrasound studies show that the needle can move back and forth, almost a quarter of an inch, making aspiration before injection very unreliable as a practice.”
The bottom line? Fillers are still safe when done by an experienced injector with the proper training of facial anatomy and technique. Atlanta plastic surgeon Foad Nahai, MD who is also ASJ’s editor in chief, says he was excited to publish the study to dispel a myth but shares that filler injections are for the most part safe. “Rare complications can be devastating but that shouldn’t stop anyone thinking about getting fillers. Experienced injectors know the anatomy and we know the danger zones.”
“Filler injections may be a noninvasive procedure, but they are still a medical procedure,” says La Jolla, CA plastic surgeon Robert Singer, MD. “They have risks, and they need to be done in the hands of an appropriate medical provider who has extensive experience. By using certain techniques, they can avoid these problems. The likelihood of these problems is very low, and the majority of patients who have fillers have a good outcome and it’s done safely.”