We live in a privileged aesthetic time of non-invasive upliftment and enhancement. Pre-rejuvenation is the buzzword, and treatment modalities abound, with optimal results often lying in the synergistic use of wisely chosen procedures. This is where the art lies, writes Dr Izolda Heydenrych*.
The use of dermal fillers is central to the aesthetic practitioner’s armamentarium. Although rare, complications may occur with the aesthetic use of fillers, the majority of which are related to either inappropriate patient selection or issues of sterility, placement, volume and injection technique. The choice of filling agent is also of paramount importance.
Selecting appropriate patients or, perhaps more importantly, not treating inappropriate patients, is the first and most crucial step in avoiding complications with dermal fillers. In this regard, the enlightened patient may play a powerful role in the prevention of unwanted sequelae.
Patient-related factors precluding fillers may be seen as skin-related or systemic, and include:
- Infectious:viral (Herpes simplex), bacterial (streptococci or staphylococci) and acne. Prophylactic antivirals should be considered in patients with a known history of HSV to prevent reactivation due to needle trauma. Other infections should be completely cleared,with restoration of adequate barrier function, before treatment.
- Inflammatory: active dermatitis and rosacea. Restoration of skin barrier function may take two to four weeks after clearance of the active problem.
- Systemic: sinusitis; periodontal disease; ear, nose or throat infections; and dental abscesses.
- Auto-immune:active rheumatoid arthritis, lupus erythematosus and other connective tissue diseases may be aggravated by filler treatment.
Increasingly, clinical evidence is emerging indicating that infections might subsequently invade implanted filler areas, inducing biofilm reactions. Later, transition from infection to an established hypersensitivity, via toll-like receptors, is also possible.
There are a number of steps that should be taken, and other procedural time frames taken into account, before patients undergo dermal filler treatment. These include:
- Medications: anti-inflammatory and antiplatelet agents should be stopped a week prior to treatment (if medically appropriate) to minimise bruising.
- Food stuffs that compound bruisability – such as omega 3, salmon oil, vitamins E and C, ginko biloba, red wine, grapefruit, dark chocolate – should be avoided for at least a week prior to treatment.
- Procedures decreasing skin barrier function (lasers, chemical peels, etc.) should be timed two to four weeks before or after fillers.
- Vaccinations and dental procedures should be performed at least two weeks before or after fillers.
- Chlorhexidine mouthwash prior to perioral injections will reduce oral bacterial flora for eight hours, also minimising the risk of contamination when lip licking.
The use of fillers over previous permanent or late biodegradable fillers is strongly discouraged, as it is generally accepted that these are associated with substantially higher incidence of side effects, sometimes occurring years after implantation.
Making the right choice
The market is flooded with products, not all of which are equally safe or efficacious.It is strongly advised that the chosen product be reversible and from a company providing good support in the event of adverse effects. The practitioner performing the procedure should have excellent knowledge of anatomy, technique, safety aspects and product science.
Patient selection is a crucial and often neglected area of aesthetic practice and the active involvement of well-informed patients is becoming increasingly necessary in the safe-guarding of cosmetic procedures.
Contact Allergan South Africa for more information : www.allergan.co.za
*Dr Heydenrych is the president of the South African Society of Dermatologic Surgery, founding member of the African Women’s Dermatological Society, South African representative of the International Allergan Medical Aesthetics Academy and key opinion leader for L’Oreal/SkinCeuticals/La Roche Posay.
This article was written by Dr Izolda Heydenrych and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine September Spring 2016 Edition (Issue 19).
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