- Introduction of multiple injectable cases with non-satisfactory results or with complications
- Discussion between the speakers and the attendees about the cause of this situation
- Suggestions from speakers to prevent similar cases
- Dr. Dalvi Humzah, MD, BSc, MBBS, AKC, FRCS, MBA (Plastic, Reconstructive and Aesthetic Surgeon) Bio
- Dr. Gurnam Virdi, MD (Aesthetic Physician) Bio
- Dr. Reza Akef, MD (CCFP-EM, Aesthetic Physician) Bio
- Mohsen Talani, MD (Anatomist) Bio
By completion of this course, you will receive a CME certificate for 1 credit.
The first patient is an 18 years old girl who wants a lip enhancement with HA. She was injected by an experienced nurse practitioner with a needle. The reason for using this case is that a lot of people in this industry say we have been injecting for 5 years, 10 years , so a complication will never happen to them but it is just a matter of time before we encounter a complication and to be fair with you it is not a big deal because it is the complications that make us a better practitioner. It is not only about dealing with the complication, but the recognition is also just as important and hopefully, we can go through that in this webinar.
There are 2 things that we can do when a complication occurs either in an immediate situation which would have been after the treatment or when the patient will come back to the clinic: Pain score & Cap refill. We believe that pain score is hugely underrated, sometimes it is a simple question after your first injection especially in the lips, what is the pain score out of 10? If for whatever reason after treatment it goes up to 7, 8, or even 10 then you know to do further checks because it may be potentially something underlying that you didn’t figure out. The other thing that is very important is capillary refill to see how well-perfused the tissues are going to be where ever the injected area was.
Common vascular compromise signs are pain out of proportion, skin color change, and pustules/papules. Hot compress, Aspirin, Hyaluronidase, antibiotics, and steroids can be used to manage these complications. With all that being said the prevention is better than cure and by prevention, we mean knowing what’s superficial and what’s deep. The most important thing in facial aesthetic is the D-word and that’s depth. Knowing that will keep you out of trouble.
The second case is about cheek swelling. The patient is a 54 years old lady who had a HA filler to her cheeks 2.5 months ago and had developed a red area and her practitioner had treated her with Erythromycin but it hadn’t resolved the redness and she developed swelling. She has got a large cavity extending up the cheek and it is full of necrotic material. We will talk about the investigations that we did to find out the reason behind this swelling in detail.
A long time ago when we were involved in doing permanent fillers, we would say permanent fillers, permanent problems but now we will tell you that even with temporary fillers you can have permanent problems. We always have to be very careful that how we do our injections, how prepare our patients, how we look after the patients, post treatment to avoid anything like infections because if infections have been left alone and not diagnosed early, they will give us significant problems. Once an infection becomes an abscess, it will destroy your fat cells and cheeks and you will be in a lot of problems.
Finally, if you got an abscess and swelling, antibiotics won’t treat it. You should drain it with a big needle and send it to microbiology so you can give them the proper antibiotics. If you got an abscess it’s got to be drained and then when you drained it you are looking at long-term problems that have to be dealt with as well.