CATEGORY 56 AUSTRALASIAN DENTIST When treating patients with botulinum toxin or filler, we should use a systematic, effective strategy aimed at reducing the risk, particularly from dermal filler complications. It is achieved through conscious awareness and careful preconsideration of the possible confounding factors.  Procedural planning and aseptic technique. Procedural planning is essential in preventing breaching of the clean workspace. Ensuring that everything is at hand before initiating the treatment helps to reduce breaks in the aseptic field and the concomitant risk of injectionrelated infections. As with all aesthetic procedures, a preconceived plan aids in a clear procedural flow that minimizes complications. Stringent aseptic technique is mandatory. The patient’s skin should be cleaned and disinfected. There are no universally recommended topical antiseptics, but chlorhexidine, alcohol, and iodine may be appropriate, and at Dermal Distinction Academy, we routinely use alcohol swabs. Makeup should be removed, or better yet, the patient should be asked to avoid wearing makeup to the appointment. The skin cleansed carefully with 2% chlorhexidine gluconate in 70% alcohol, avoiding ocular exposure to the disinfectant. When performing lip fillers, rinsing the mouth with an antiseptic mouthwash containing chlorhexidine reduces bacteria in the oral cavity for up to 8 hours and has been suggested as a preventative practice when treating the perioral area. The practitioner should remove all jewelery, wash their hands with antiseptic cleanser, and use gloves for all cases of injection therapy. The procedure is not deemed to be sterile as the syringe itself is not completely sterile. Therefore, once the practitioner holds the syringe, sterility is lost and aseptic technique is of paramount importance. Transferring the surgical principles of sterile technique by not touching any component of the needle or cannula that penetrates the skin may CLINICAL further reduce the prevalence of infective complications. Constant vigilance against possible contamination is of utmost importance. I would recommend cleansing the skin, and then cleansing again and again as you complete the treatment. Cleansing over a sufficiently broad area is imperative as there is a higher infective risk upon inadvertent resting of the cannula on the adjacent skin. Frequent changing of needles and cannulae is advised when utilizing multiple entry points. It is really important to also avoid wiping the cannula across the skin, or touching it with your hands. Where the cannula does come into contact with the skin, please wipe the cannula with an alcohol wipe to remove any skin microbiome, therefore reducing the incidence of a biofilm developing. The use of disposable sterile dressing trays with containers for prep solution, gauze, and disposable sterile drapes provides a convenient and inexpensive way to establish a safe, clean work area in an office setting. Applied facial anatomy Knowledge of applied facial anatomy is of paramount importance and serves as the foundation for avoiding disastrous complications. Multiple documented variations and classifications of the vascular arcades in the face render it impossible for the injection specialist to determine the patient’s anatomy. There is no 100% guarantee of avoiding vascular injury once the needle or cannula has penetrated beneath the skin. The most common complication is bruising, which is acceptable. Our role is undertake treatments in the safest way possible, but we must remember that no technique is 100% safe. There are safer techniques, where the risk is reduced. The location of the tip of the needle or cannula determines the location of the deposition of product and, its embolic potential. Nonetheless, potential danger areas can be identified by clear anatomical understanding of the depth of neurovascular structures across specific facial zones. Cosmetic practitioners should fully understand the appropriate depth and plane of injection (safety by depth) at different sites of treatment. Facial injection Facial Rejuvenation: A good plan! Dr Giulia D’Anna By Dr Giulia D’Anna, BDSc, MRACDS, FIADFE, Grad. Dip. Derm. Ther Cert IV TAE, Grad. Cert laser giulia@dermaldistinction.com.au
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