Years ago, plastic surgeons focused the majority of their time on larger operations and were not “injection oriented”. Many of those smaller procedures were delegated to nurses and estheticians. Many are now realizing that fillers and neurotoxins have become an integral and necessary part of a complete cosmetic surgery practice. In our practice, I have always done his own injections and has been doing them daily for 13 years.
BOTOX® Cosmetic and injectable fillers are capable of causing complications and most complications are the result of the injection technique, meaning they are the fault of the injector. It is important to differentiate common results from complications. Swelling and redness are common results; while hematoma, overcorrection, or granulomas are complications. The risk of these complications is directly related to the experience of the person doing the injection.
Some of the more commonly seen filler “complications” include the following:
- Uneven fill
- Herpes outbreak
Adequate pain control is extremely important. One thing that has always amazed and bothered me is the cavalier attitude that many injectors take when it comes to pain control with filler injection. I believe that all injectors should get filler injections themselves. This will make them think differently. I believe in proper local anesthetic prior to injecting the fillers. Injecting a numb patient is a better experience for both myself and my patient, and a more precise procedure can be performed when pain is controlled. Many filler patients that have come to my office, who have had filler injection in other practices have become my permanent patients because my procedure was painless.
I also believe that documenting the exact type of filler, location of injection, and quantity of fill is extremely important with each visit. This way we can adjust the treatment on each subsequent visit according to the outcome of the previous injection. Although the fillers may last up to twelve months, many patients return for repeat injections prior to that time so that less is needed and the results are more subtle.