CATEGORY 72 AUSTRALASIAN DENTIST which is often out of reach for the general injector, but gives the best detail. e more expensive machines are also large in size, and give accurate highly detailed images. So if you have a cheaper handheld device, you may simply not be able to see what you need to see. Furthermore, incorrect use of ultrasound may signi cantly increase the risk of your cosmetic treatment by giving clinicians a false sense of security, meaning they may be more likely to inject in risky ways, and inject areas that are beyond their scope of practice and training. So for example, you may perform ultrasound on the nasolabial fold and see no blood ow through the area. Now we know that anatomically this area carries the facial artery and is high risk. u What does the absence of the expected key elements in the images tell us? u If the ultrasound shows no blood ow, does this mean that you are safe to inject? u Does it mean that the ultrasound could not see the blood ow and you will now proceed to inject in an area that you might not have before? Does this actually increase your risk, since you assume you are now safe? u What if your ultrasound is not correctly calibrated? u What if you press too hard on the ultrasound probe and occlude the vessels? Perhaps some of these questions begin to highlight that when we add technology into our clinical practice, we need to consider where there might be gaps in the technology, our skillset or our ability to objectively look at the data and potential errors that creep in. Look at the images below. ey were taken of the same tissue with three di erent ultrasound devices. e rst image is most de ned and the most expensive equipment. e middle is midrange and the nal image is using a cheaper hand held machine. Some things to seriously consider when clinics advocate their treatments because they are done under ultrasound guidance include: u What experience do the practitioners at the clinic have? e use of ultrasound is unlikely to replace training and experience in reducing risk through safe injection techniques. u How much experience do they have with ultrasound? Most practitioners will have just bought the device and done a weekend course. is means that the ultrasound is unlikely to be performed correctly, increasing risk through a false sense of security. u Will the use of ultrasound make the injector take unnecessary risks because 4. e rate of false negative is unknown (We do not know how commonly we scan an area, see no vessel, and inject under the false assumption that the area is free of vessels. ere is no data to show an improvement in safety or an increased risk. We simply do not know). 5. Ultrasound does help you aid your anatomical learning, if you regularly practice using the ultrasound and have good equipment. 6. It also give you a better understanding where your injections actually are being delivered. 7. Ultrasound also allows for a better ability to di erentiate between a Vascular Occlusion on Day 0 and day 1, where you may be confused whether you are seeing a bruise or something more. Again keep in mind that this requires a high quality piece of equipment. 8. ey also allow you to better identify a high risk anatomical variation before injecting, if your equipment is good quality, well calibrated and well maintained, and you have great training. Keep in mind all of this is based on using a high quality, usually expensive machine. Ultrasound may have utility in improving dermal ller safety, but mainly with the treatment of complications by allowing precise dissolving of dermal ller that has caused the issue. At this time, there is no data to prove that the use of ultrasound reduces risk as there are far too many variables, and no studies available. At this time, we will watch the space, and see what emerging science comes forward. Reducing risk is always of bene t to our patients and always something we should take into account. At this time, Dermal Distinction Academy recommend that you undertake intense anatomy training and use rigorous cosmetic injecting protocols to help improve your outcomes, with the inclusion of injecting with a cannula. is has proven risk reduction and is the standard practice in cosmetic injecting. For now, we will watch the technology space with interest. u To undertake training in cosmetic injectable treatments in an accredited practice, please visit www.dermaldistinction.com for more information and to enrol. ultrasound is giving them con dence they otherwise would not have? u Does ultrasound actually result in better patient outcomes (either with a better result or risk reduction)? u Does the use of ultrasound increase the severity of complications because injectors think they are in the clear when they in fact are not? u Ultrasound was not designed to be used for dermal ller detection. Nothing is ever likely to replace safe and experienced techniques when reducing the risk of dermal ller injections. e same debate has occurred countless times with previous techniques and tools. e use of a cannula vs sharp needle, to aspirate or not aspirate. Both the use of a cannula and aspirating before injecting were claimed to be safer techniques, and while they may reduce the likelihood of a complication, some of the worst complications have occurred when dermal ller has been injected because the practitioner forgot anatomy thinking that they were “safe”. Ultrasound is no di erent, and from previous experience, the over-con dence that comes with these practices that emphasize ‘safety’ often expose patients to a much higher risk than they would be if practitioners simply remained cautious and conservative, and stuck to safe technique. Look at the image below of Ultrasound and HA llers. It is very di cult to visualize for the nontrained practitioner, or even the practitioner with experience. Patient injected with hyaluronic acid filler. (A) Immediately after treatment. Poorly defined globular ultrasound pattern. (B) 1 month after treatment where tissue integration has occurred. It is difficult to see the areas of treatment. Here are some other factors to consider: 1. Buying an ultrasound doesn’t make you automatically safer. It is about the level of the equipment sensitivity, ease of use, calibration and so on. 2. Injecting under ultrasound removes the bene t of watching the skin and watching your aesthetic volume changes 3. Injecting under ultrasound makes it harder to keep the cannula sterile and has the potential to increase bacterial contamination that may increase risk of delayed onset nodules CLINICAL
RkJQdWJsaXNoZXIy MTc3NDk3Mw==