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  • Presentation

To Aspirate or Not to Aspirate?

Description

The presentation focuses on the debate surrounding the practice of aspiration before injecting fillers, with one presenter advocating for its use while another opposes it. Aspiration is intended as a safety measure to avoid injecting fillers into blood vessels, which can lead to serious complications like necrosis, vision loss, or stroke. While the incidence of vascular events is relatively low, the potential consequences are severe. Supporters of aspiration argue that it can detect whether the needle has entered a vessel. Opponents raise concerns about false negatives, instances in which blood is not withdrawn even though the needle is in a vessel due to vessel wall collapse or other factors. Research indicates that aspiration success may vary with different fillers, needle sizes, and techniques. Studies show variable results, suggesting that aspiration can be beneficial when done correctly, with optimal techniques including slow pullbacks for a longer duration and priming syringes appropriately. The speaker emphasizes the need for better standardization of the aspiration process, further research to refine techniques, and suggestions for improved syringe design. Overall, while aspiration remains a controversial topic, it is acknowledged that no single method guarantees absolute safety in filler injections.

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Conclusions

  • Aspiration is considered a safety measure during filler injections to reduce the risk of vascular occlusions.
  • The overall frequency of vascular events related to filler injections is low but can result in severe consequences such as necrosis and vision loss.
  • There are conflicting opinions among practitioners regarding the necessity of aspiration due to high false negative rates.
  • In vitro studies show that aspiration can yield positive results at varying rates depending on the timing of aspiration and the types of fillers used.
  • Technique and equipment (such as needle gauge and filler viscosity) impact the effectiveness of aspiration.
  • In vivo studies also support the clinical utility of aspiration as a preventive measure against accidental intravascular injections, especially when considering the right combinations of fillers and needles.
  • The technique of aspiration should be refined, with suggestions including improved syringe designs, consistent training, and the use of priming with saline for better outcomes.
  • There is no recognized safe threshold for filler volume that can be injected intravascularly without causing complications; even minimal amounts can potentially lead to adverse effects.
  • Schelke, L., Decates, T., Kadouch, J., & Velthuis, P. (2020). Incidence of Vascular Obstruction After Filler Injections. Aesthet Surg J, 40(8), NP457-NP460. doi: 10.1093/asj/sjaa086
  • Kapoor, K. M., Kapoor, P., Heydenrych, I., & Bertossi, D. (2020). Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature. Aesthetic Plast Surg, 44(3), 929-944. doi: 10.1007/s00266-019-01562-8
  • Beleznay, K., et al. (2019). Update on avoiding and treating blindness from fillers: a recent review of the world literature. Aesthetic Surgery Journal, 39(6), 662-674.
  • Carey, W., & Weinkle, S. (2015). Retraction of the plunger on a syringe of hyaluronic acid before injection: are we safe ?. Dermatologic Surgery, 41, S340-S346.
  • Jewell, M. L. (2022). Commentary on: Aspiration Before Tissue Filler-An Exercise in Futility and Unsafe Practice. Aesthetic Surgery Journal, 42(1), 102-105.
  • Goodman, G. J., et al. (2022). Aspiration before tissue filler-an exercise in futility and unsafe practice. Aesthetic Surgery Journal, 42(1), 89-101.
  • Van Loghem, J. A., Fouché, J. J., & Thuis, J. (2018). Sensitivity of aspiration as a safety test before injection of soft tissue fillers. Journal of Cosmetic Dermatology, 17(1), 39-46.
  • Wang, J. V., et al. (2020). Utility of pre-injection aspiration for hyaluronic fillers: a novel in vivo human evaluation. Journal of Cutaneous Medicine and Surgery, 24(4), 367-371.
  • Moon, H.-J., et al. (2021). Aspiration Revisited: Prospective Evaluation of a Physiologically Pressurized Model With Animal Correlation and Broader Applicability to Filler Complications. Aesthetic Surgery Journal, 41(8), NP1073-NP1083.
  • Kogan, I., et al. (2020). In vitro evaluation of aspiration of hyaluronic acid filler with a new saline flashing method. Journal of Cosmetic Dermatology, 19(10), 2513-2518.