CATEGORY 70 AUSTRALASIAN DENTIST CLINICAL Dr Giulia D’Anna By Dr Giulia D’Anna, BDSc, MRACDS, FIADFE, Grad. Dip. Derm. Ther Cert IV TAE, Grad. Cert laser, Email: giulia@dermaldistinction.com.au Dermal ller injections are one of the most popular treatments in our cosmetic industry for enhancing and rejuvenating the appearance of the face. While widely considered a low-risk treatment in trained hands, many patients are still frightened of the risks of dermal ller. is can sometimes also translate to the practitioner being scared of treating patients. Of course we all want great outcomes and happy patients. In Australia, the most common dermal ller used to created lip enhancement and cheek contour improvement is made from Hyaluronic acid. Delivered as a gel in a syringe of various rheological pro les, dermal ller is injected using a traditional needle or a blunt-ended cannula. When the gel in injected, there is a volumization of the tissues to enhance and improve contours. As we know, all procedures carry risk. ere are common risks when it comes to cosmetic injecting such as discomfort, swelling and bruising. ese are not serious in nature and are not associated with poor outcomes. Risks in cosmetic injecting As mentioned, there are common risks that are acceptable such as bruising and temporary swelling associated with injecting. Risks of more signi cance are vascular occlusion. A vascular occlusion occurs when blood is no longer able to pass through a blood vessel, where the gel in inadvertently injected into a blood vessel causing a blockage. is can cause skin damage and/or necrosis if the vascular occlusion is not treatment. A blockage may also occur distant to the site of injection, resulting in blindness. is is where a blockage travels upstream, higher up the chain into the ophthalmic blood vessels. ese are risks that we need to inform our patients of to gain full consent. We should include the statistics when we are having our consultation. e reported risk of a vascular incident when injecting ller using a needle is 1:6410. Comparing the risk of the same ller being injected with a cannula, the risk is much lower being close to 1:40187. is means that using a cannula reduces the risk signi cantly. When we discuss blindness, the accepted risk to quote our patients is Does technology make cosmetic injecting safe? that blindness may occur in one in every 100,000 injections. It has occurred twice in Australia and is devastating to the patient, but also to the practitioner. So the question is, can we reduce the risk with technology such as ultrasound? e simple answer is that we cannot quote reduced risk gures to our patients when we use ultrasound and dermal ller. So statistically speaking, using ultrasound is not safer. From skin damage to blindness, the risk of dermal ller complications can frighten people away from having what could otherwise be a life-changing treatment. While nothing will ever compare to the safety of having your dermal ller by a clinician with extensive training and experience, a newer technique known as ultrasound-guided dermal ller injections has gained signi cant attention in recent times. But just because it is newer does not necessarily make it better. I know that this is an area of much discussion, but it is important to note that the use of ultrasound for any cosmetic injections is not standard procedure, nor have any rules changed around the use of this equipment. So let’s break down ultrasound and the use in cosmetic injecting. How can it be bene cial and are all devices the same? Ultrasound technology Ultrasound technology has been around for decades, and has changed the practice of medicine. It is a simple, non-invasive way to visualize tissue beneath the skin and identify anatomical structures, and diagnose certain diseases and medical conditions. Ultrasound uses highfrequency sound waves to produce images. It works by emitting sound waves that bounce o internal structures of the body and return to a device called a transducer. e transducer converts the re ected sound waves into images that are displayed on a monitor. In the context of dermal llers, ultrasound can be used to map out planned treatment areas and identify key structures that must be avoided during the treatment. It can also be used to track the progress of your treatment in real time, assess the location of previously injected dermal llers, and to identify and treat dermal ller complications. Advocates of ultrasound guided dermal llers injections claim that it reduces the risk of complications, enhancing patient safety. However, currently, there are no peer-reviewed longitudinal studies demonstrating that ultrasound-guided dermal ller injections improve outcomes and reduce risk. While theoretically they might, theory doesn’t always translate into practice. Just because a clinic o ers ultrasound guided injections of dermal ller does not mean that the treatment will have no risk, and does not guarantee a result. Skilled sonographers who specialise in performing ultrasound scans spend years learning how to perform them correctly and accurately. It is also very important to remember, like all things with technology, you get what you pay for. Cheaper devices run around the $6-7K. And having one will make you feel like you are reducing risk, but what you see with a cheaper device is poor clarity and de nition. So this can give you a false sense of security as you see no vessels, and potentially might progress with treatment thinking that you are safe. A skilled sonographer uses an Ultrasound device that runs around $80K+,
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