Aspiration before injecting dermal hyaluronic acid fillers – yes or no?
Aspiration before injecting dermal hyaluronic acid fillers – yes or no?
This topic is the subject of controversial debate in the medical community, and there is still no consensus on it.
In a recently published review, Goodman et al. (Aesthet Surg J. 2021 Apr; 41(4): NP134–NP136) state the following:
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1. There is agreement that vascular occlusion (and, as a consequence, blindness for example) is the actual event that an aspiration process is intended to avoid where possible. However, there is currently NO evidence that aspiration actually offers such protection.
2. A negative aspiration (no blood after aspiration) may be observed when the needle tip is in fact not in a vessel (true negative) or also when the needle tip is nevertheless in a vessel but - owing to the rheological properties of the blood flow or a collapse of the vessel - no blood is aspirated (false negative).
3. Negative aspiration rests on the premise that the tip of the needle or cannula is in fact permanently stationary throughout the entire aspiration process and that movements of the syringe during aspiration and injection do not further affect the placement of the filler substance.
4. Studies published on this topic to date often consider positive aspirations alone but neglect false-negative aspirations.
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Our conclusion:
Aspiration does not offer complete protection against the possibility of vascular occlusion. If vascular occlusion is suspected: stop the injection immediately and treat. Aim: promote blood flow to the affected area.
Treatment (vascular occlusion): hyaluronidase (immediately to the entire area of ischaemia & periodically for as long as symptoms persist), warm compress, massaging/tapping & application of 2% nitroglycerin paste to promote vasodilation, acetylsalicylic acid
Reduce the risk through: knowledge of anatomy, slow injection, small (serial) volumes in high-risk areas, treating one side after the other, lifting the skin to create more distance from the branches of the main arteries, use of blunt cannulas
Source:
Goodman et al. (Aesthet Surg J. 2021 Apr; 41(4): NP134–NP136)