CATEGORY 58 AUSTRALASIAN DENTIST CLINICAL anatomy training is specific for nonsurgical syringe therapy and is highly advisable for optimal results and avoidance of complications. Note: In the anatomy dissection image, The hook holds orbicularis oculi muscle showing the anastomosis between intra and extra-vascularisation of the orbit. Technical knowledge Knowledge of optimal placement and injection depth is cardinal to the aesthetic success of dermal fillers. Superficial placement may lead to adverse effects such as surface irregularities and the Tyndall effect. We will look at this complication in later lessons, but have added it here for completeness. The hallmarks of wise injection technique include slow injection speed with least amount of pressure and small bolus size. Although controversial, the merits of aspiration before injection (especially in high-risk areas), vs constant movement of the tip of the needle, should be considered. I personally do not aspirate as the constant movement of a cannula negates any reading, and creates a false sense of security. Incremental injections of 0.1–0.2ml of the product should be used while continually monitoring the skin of the surrounding area. Rapid injection speed, aggressive fanning, high-volume filler deposits, and large bolus size induce increased incidences of bruising, and the occurrence of delayed inflammatory reactions. The cosmetic practitioner should understand the relative risks and advantages of using a needle vs cannula. Small-bore needles are recommended by some to slow the injection rate, and blunt cannulae are suggested in high-risk regions in an attempt to reduce vessel injury. Dr Lee Walker (March 2022) quotes the risk as: u Vascular incidence when using a needle is 1:6000 u Vascular incidence when using a cannula is 1:40000 u It is therefore much safer to use a cannula when possible. Surgery, scarring, or multiple previous procedures may increase the risk of cannulating a vessel. This is simply because the vascular structures may have been repositioned as part of the surgery. Implant card It has been a mandatory requirement for a number of years to provide your patient with a dermal filler implant card. This card can be delivered electronically or as a physical card. A dermal filler implant card should contain essential information to ensure traceability, patient safety, and proper follow-up care after a dermal filler procedure. Here’s what it typically needs to include: 1. Patient Information: u Name of the patient u Date of the procedure 2. Clinician Information: u Name of the clinician or practitioner who performed the procedure u Contact details of the clinic or practice (after-hours) 3. Product Information: u Brand name of the dermal filler used u Lot or batch number of the product u Expiry date of the dermal filler u Amount or volume of product used (in milliliters) 4. A dverse Reactions and Follow-up Instructions: u Possible side effects and risks of the treatment u Aftercare instructions u Emergency contact information in case of adverse reactions 5. Traceability Information: u A barcode or serial number that links to the batch of dermal filler u Manufacturer’s name and details of the product The implant card ensures that the patient has all necessary information for postprocedure care and that in case of any issues, the filler can be traced back to its source. It also aids future treatments or consultations with other practitioners, especially in the case of a vascular or occular emergency. Post-treatment checklist 1. Routinely check perfusion in the treated areas as well as areas with watershed perfusion (glabella, nasal tip, and upper lip) ensuring that makeup is not obscuring skin tone. Initial signs of vascular compromise may be subtle. 2. The patient should be provided with written post-treatment instructions and contact numbers. Vigilant observation of skin color change, which may be remote from the injection point, is mandatory. Although usually immediate, the onset has been reported to be delayed up to 24 hours. 3. The cosmetic practitioner should be available telephonically for 48 hours postprocedure. 4. It is good practice to have a staff member call the patient the next day. 5. Where possible use Ultrasound or other imaging to make a pre-operative assessment. You may also like to make a post-operative assessment to ensure that vascularity has remained intact. Imaging can also help assist you in determining if the patient has bruising or a vascular blockage when you might be confused after treatment. This can save the patient from discomfort, and irreversible skin changes. u To learn more about cosmetic injecting with an ethical approach, and also putting the safety of your patient first, reach out to Dermal Distinction Academy at www.dermaldistinction.com TheraBase Ca® Self-Adhesive Calcium Releasing Dual-Cured Base Easier, Stronger, Longer-Lasting than RMGI and GI $199 Incl GST + free 1gm TheraCal LC with every 8gm syringe Footer Ads #106.indd 4 10/10/2024 12:37:45 PM
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