COMPLICATIONS, ULTRASOUND & DISSOLVING
There's a lot of confusing and conflicting information on social media regarding the complications management of injectables. Most patients have a lot of questions including:
- Who is the best person to treat these types of issues?
- What actually happens when products are injected into the tissues of the face?
- How long do these products last?
- What is the role of aesthetic ultrasound and when is it needed?
- What happens to your face and skin when fillers are dissolved?
- What are the risks of using filler dissolving products?
If you're wanting a second opinion from Dr Jake regarding managing a complication from another injectors work, please read the information on this page carefully and then complete the form at the bottom of the page. Dr Jake will then triage your enquiry and get back to you if he can help.
Filler dissolving isn't suitable for all products or all situations. Without the right information to make a judgement call, Dr Jake will politely decline seeing you.
WHY IS THE MANAGEMENT OF COMPLICATIONS SO TRICKY?
Patients often lose trust with their previous injector after a complication. Whilst this is understandable, complications can happen in the best injectors hands. The risks of your treatment will have been explained to you when you signed a consent form prior to your treatment and so rarely, these do happen. Therefore instead of cutting ties with your old injector, the best person to see is them.
They will know exactly what product was used, how it was injected, how much was used and what layer of the face it was placed. Dr Jake strongly advises patients with a complication to contact their treating injector as the first port of call and explain your concerns. Any reputable injector would not only be happy to see you, but it's their duty to try and help you given that they were medically and legally responsible for your treatrment.
THE ROLE OF ULTRASOUND IN AESTHETICS
Ultrasound has become an incredibly useful tool in Dr Jake's practice - but it is not always needed and sometimes patients get confused about what it's for. Around 99% of injectors do not have ultrasound in their clinics and yet routinely dissolve old fillers all the time with no difficulty. This is why you're encouraged to see your original injector first because it shouldn't require specialist help. Dr Jake uses ultrasound for three main reasons: 1) To help identify and avoid the main blood vessels in particular areas of the face This is sometimes referred to as 'vascular mapping'. Dr Jake doesn't do this routinely but for specific areas of the face such as the nose, temple or deep lines close the the nose, he may scan the areas prior to considering a facial volumising treatment. 2) To treat filler emergencies known as 'vascular occlusions'. If a facial volumising product is inadvertently injected into a blood vessel, this can compromise the blood supply to the skin of the area. In this scenario the product should be dissolved as soon as practically possible to avoid compromise of the blood supply of the skin. Using ultrasound is now accepted by many experts to be the gold standard in managing these complications because it can assess the blood supply of the area, visualise the areas of filler placed and help to target more precise dissolving of the product. 2) To assess old fillers that may have become problematic or are resistant to dissolving If an area of volumising product is older, it can sometimes get 'walled off' by scar tissue or similar. This can make it resistant to dissolving product. The old product can usually be visualised seen using an ultrasound device and this can then help plan a dissolving treatment, occasionally by targetting the area under ultrasound guidance. Ultrasound guidance is rarely needed and the best person to any dissolve old product is the injector who initially treated you
WHAT TO KNOW BEFORE CONSIDERING A DISSOLVING TREATMENT
Pre-dissolving MRI scans Very occasionally Dr Jake will request that a facial MRI scan is done before considering a dissolving treatment. This is the exception and not the rule but in atypical cases, it will help Dr Jake plan for any future management. (He may also consult with some other global experts with the results of your scan including Dr Mobin Master & Dr Daniel Ezra) Dr Jake will provide you with a referral for the scan to be done at the Mater Hospital, Sydney. You will need to go to this specific hospital where Dr Jake will then liaise with their Consultant Radiologist who has expertise in managing filler complications. The report and scan images from the hospital will need to be made available to Dr Jake prior to your consultation and he will advise you how to organise this if required. Dissolving isn't always best In one of the latest clinical studies on this topic, approximately 20% of patients were unhappy at how empty, deflated or different the areas looked after being dissolved. Therefore undergoing a dissolving treatment isn't always the best option and the results could distress you more than the current look you have. This is a situation that should be anticipated and planned for to avoid further anxiety about how you look. Therefore a conversion about this will be had in your consultation with Dr Jake. Occasionally on balance it might be better having poorly placed filler than dissolving the product that will likely leave you with looser, hollower, saggier and crepier-looking skin. Dr Jake will do his best to help you make this judgement call in your consultation and be honest about what he thinks is best for you. On the day of your consultation Dr Jake will re-explore what happened in your previous treatment/s and examine the areas with photos, hands on and an ultrasound scan will usually be done. If a dissolving procedure is indicated, this doesn't always need special ultrasound guidance. More and more patients who seek complications management request for it to be done under ultrasound guidance in the belief that is it required and more accurate. This is not necessarily true and each situation will be managed on it's merits. Whilst ultrasound can useful, is only an tool that's needed in certain situations. Unless the product that is very focal, very deep or very difficult to reach that warrants ultrasound guidance, it will usually be dissolved without ultrasound. It will never be possible to remove all the filler in its entirety. Filler when viewed under ultrasound is typically seen as tiny 'granules' that are scattered and mixed amongst your own natural tissues over a wide area. Patients wanting all of their old fillers 'removed' should not book for this service with Dr Jake as it;s simply not realistic nor necessary. There is no guarantee of achieving this whatsoever and therefore Dr Jake doesn't see patients wanting this Costs Regarding costs, the new TGA laws prohibit clinics from quoting prices to patients who haven't yet had a consultation. This is frustrating but we have to abide by the law. Dr Jake again strongly encourages patients with complications to contact their original injector as the first port of call. They may be able to help you as a complimentary part of their ongoing service to you as their original patient.
KEY FEATURES OF ULTRASOUND & DISSOLVING TREATMENTS
Consultations
New patient filler consultations = 60 mins
(This includes the consultation, ultrasound examination +/- dissolving if indicated)
Improving safety
Even the best injectors will experience complications - they are medical procedures. But embracing technology like ultrasound can help reduce the risk of vascular occlusions and blindness.
Accurate dissolving
We now know that the most commonly used fillers will remain in our tissues for 10+ years. If problematic, they can usually be seen using ultrasound to help plan a dissolving treatment.
Emergency treatments
Injectors without experience in treating vascular occlusions will often struggle to locate the problem area. Ultrasound can help make filler dissolving quicker and reduce harm to patients.
DOWNTIME & AFTERCARE AFTER
A DISSOLVING PROCEDURE
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Some swelling or tenderness at the injection sites is very normal. This can take a few days to recover.
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Bruising is possible after a dissolving treatment and for the lip area this can sometimes be extensive.
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After dissolving fillers (and particularly ones that have been in the tissue for a long time), visible hollowing, 'emptiness' and sagging of the area can occur. It can be distressing to look more tired, empty or saggy.
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There is no evidence that filler dissolving affects the natural tissues of the face at all. Dr Jake is aware that this is sometimes claimed on social media but there is no proof of it to date
APPLY BELOW
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How do wrinkle treatments work?Wrinkle treatments are performed using tiny injections that temporarily relax muscles. By targeting specific muscles of facial expression, we can soften fine lines and wrinkles seen in the skin. Over a period of around 4 months, the treatment wears off and the wrinkles will slowly return.
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How should I prepare for my wrinkle treatment?As for all injectable treatments, please come with no make up, foundation or similar on your skin. This will reduce the risk of an infection. To reduce the risk of bruising: - avoid alcohol for 24 hours prior - stop any fish oil supplements at least 5 days prior - stop any garlic, ginger, gingko biloba or ginseng in high doses - avoid any anti-inflammatory medicines (neurofen, ibuprofen, naproxen, etc) for 5 days before your treatment if possible. Prescription medicines that can make bruising much more common include warfarin or other anti-coagulants. If these are prescribed by your GP, it's not recommended to stop them. You can still have injectables but you should expect bruising to be much more common and obvious.
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What can't I do after a wrinkle treatment?You can go back to most of your normal daily activities with two simple exceptions: 1) Avoid massaging, rubbing or washing the areas injected. This therefore includes avoiding things like having a massage, facial or similar movements on the face immediately after an anti-wrinkle treatment. 2) Avoid sport, exercise or any other vigorous activity after an anti-wrinkle treatment. These rules help prevent the anti-wrinkle product spreading and affecting other muscles of the face that we don't want to treat. You can go back to all normal activities the morning after your treatment. Failure to follow these instructions will increase the risk of complications - most importantly eyelid or eyebrow drooping. These are both avoidable and reversible side effects but can take several weeks or even months to settle. Avoiding alcohol after any injectable treatment until the following day can also reduce your risk of bruising.
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What are the potential side effects?The most common side effects include: - Mild discomfort during the procedure - very temporary swellings and redness (that disappear within minutes) - bruising (always a risk when a needle is used) Rarer side effects include: - In less than 1% of cases, patients can very rarely experience eyebrow or eyelid heaviness (called a 'ptosis'). This is very rare, temporary and often resolves in three or four weeks on it's own. This might be caused by a failure to follow the after care rules described above. In this scenario, some special eyedrops might be prescribed to you to help lift the heavy eyelid but you'll need to be reviewed in person first.
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Do wrinkle treatments hurt?The injections only take minutes to perform and no special measures are needed. Dr Jake uses the smallest needles available and most patients are pleasantly surprised at how easy the process is.
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Are there any people who shouldn't have a wrinkle treatment?There are just a few but important conditions that are contraindications to wrinkle treatments: - Pregnancy or breastfeeding. (Patients trying for a baby, undergoing IVF or who are unsure if they are pregnant will also be refused treatments) - Rare neurological diseases such as Myasthenia Gravis Those taking the following medicines should also not have these treatments: - Aminoglycoside antibiotics (Gentamycin, Neomycin, Streptomycin, etc) - Penicillamine (used to treat Rheumatoid Arthritis) - A known allergy to human albumin A detailed medical history will be taken prior to your treatment but it is your responsibility to declare any medical problems to us in good time.
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How often should I have treatments?If the recommended dose is done on the day of your treatment, the results will last 2-4 months on average. Most people therefore come every 3-4 months to help maintain a consistent appearance.