Subperiosteal injections during facial soft tissue filler injections—Is it possible?

Abstract Background Pre-injection aspiration procedures could increase safety during soft tissue filler injections. However, various influencing factors have been detected in vitro that could result in false negative aspiration results. Objective A case series was retrospectively investigated to identify factors contributing to positive blood aspiration procedures in vivo. Methods This study evaluated 213 clinical cases positive for blood aspiration documented in an Asian population: 208 females (43.8 ± 7.2 years old) and 5 males (46.8 ± 7.8 years old) during soft tissue filler injections. Injection location, layer (depth) of injection, product injected, size of utilized needle (gauge), length of needle (inch), priming of needle (yes/no), injection angle (degree), and time until blood was visible in the needle hub (seconds) were evaluated. Results The most frequent location where a positive aspiration was observed was the pyriform fossa (n = 56; 26.3%), the most frequent plane was the supra-periosteal plane (n = 195; 91.5%), and the most frequent needle utilized was a 27G needle (n = 125; 58.7%). Statistically significantly more positive cases were identified when the needle was primed compared with an unprimed needle (P < 0.001, which was independent of the product). The estimated incidence rate was 0.04% to 0.9% for having positive aspiration procedures per total performed injection procedures. Conclusions Pre-injection aspiration could be a valuable tool to prevent accidental intravascular injection of soft tissue filler. The results of the present investigation show that aspiration can be performed with an acceptable aspiration time, that is, less than 2 seconds, if a suitable product/needle combination is chosen. Level of Evidence: 4

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Deformation of Needle Tips during Facial Soft Tissue Filler Injections: An Electron-Microscopic Study

Aesthetic Surgery Journal ◽

10.1093/asj/sjab211 ◽

2021 ◽

Author(s):

Mildred Lopez Pineiro ◽

Jeremy B Green ◽

Joely Kaufman ◽

Patricia L Blackwelder ◽

David L Freytag ◽

...

Keyword(s):

Soft Tissue ◽

Improve Patient Safety ◽

Influencing Factor ◽

Global Scale ◽

Facial Soft Tissue ◽

Electron Microscopic ◽

Needle Size ◽

Objective Evidence ◽

Filler Injections ◽

Soft Tissue Filler

Abstract Background Injectable soft tissue fillers are used on a global scale for a variety of aesthetic indications. Despite their widespread use, there is a dearth of information regarding the potential repeated injections into tissue have to cause needle deformation. Repeated injections with the same needle result in an increase in force used by the injector to achieve dermal penetration, potentially resulting in decreased precision and increased patient discomfort. Objectives The objective of this study is to quantify the magnitude of needle tip deformation utilizing Scanning Electron Microscopy (SEM) image analysis. Methods An observational study was performed evaluating four differently sized needles following soft tissue filler injections for five different aesthetic indications (zygomatic arch, infraorbital, mid cheek, nasolabial sulcus and perioral) in patients aged 36-64 years old. Following treatment, each needle was visualized and imaged through SEM, and the percentage of deformation in relation to the total amount of needle tip surface was calculated. Results The most influencing factor for needle tip damage was revealed to be the number of injection passes, ie, dermal transitions. Per injection procedure, an increase in needle tip damage of 4.7% occurred. Touching the bone deformed the needle tip by 9.6% and the increase in needle size allowed for 0.13% more damage. Conclusions To the authors’ knowledge, this is the first SEM investigation to provide objective evidence for the deformation of needle tips after repeated facial soft tissue filler injections. This data may help improve patient safety and comfort during these minimally invasive procedures.

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Surgeon's Guide to Facial Soft Tissue Filler Injections: Relevant Anatomy and Safety Considerations

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2017.08.026 ◽

2017 ◽

Vol 75 (12) ◽

pp. 2667.e1-2667.e5 ◽

Cited By ~ 11

Author(s):

Elie M. Ferneini ◽

Steven Hapelas ◽

James Watras ◽

Antoine M. Ferneini ◽

Drew Weyman ◽

...

Keyword(s):

Soft Tissue ◽

Facial Soft Tissue ◽

Filler Injections ◽

Soft Tissue Filler ◽

Safety Considerations

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Economic Analysis of “Liquid” versus Surgical Face-lift: Are Large-Volume Facial Soft Tissue Filler Injection Treatments a Viable Alternative to Rhytidectomy?

Facial Plastic Surgery ◽

10.1055/s-0030-1262311 ◽

2010 ◽

Vol 26 (04) ◽

pp. 296-302 ◽

Cited By ~ 1

Author(s):

Joseph Biskupiak ◽

Anthony Sclafani

Keyword(s):

Soft Tissue ◽

Economic Analysis ◽

Large Volume ◽

Viable Alternative ◽

Facial Soft Tissue ◽

Face Lift ◽

Filler Injection ◽

Soft Tissue Filler

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Adverse effects after use of polyacrylamide gel as a facial soft tissue filler

Aesthetic Surgery Journal ◽

10.1016/j.asj.2007.12.005 ◽

2008 ◽

Vol 28 (2) ◽

pp. 139-142 ◽

Cited By ~ 18

Author(s):

A KALANTARHORMOZI ◽

N MOZAFARI ◽

M RASTI

Keyword(s):

Soft Tissue ◽

Adverse Effects ◽

Polyacrylamide Gel ◽

Facial Soft Tissue ◽

Soft Tissue Filler

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The Change of Plane of the Supratrochlear and Supraorbital Arteries in the Forehead – An Ultrasound-Based Investigation

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa421 ◽

2021 ◽

Author(s):

Sebastian Cotofana ◽

Peter J Velthuis ◽

Michael Alfertshofer ◽

Konstantin Frank ◽

Vince Bertucci ◽

...

Keyword(s):

Soft Tissue ◽

Linear Array ◽

3 Dimensional ◽

Deep Branch ◽

Array Transducer ◽

Ultrasound Findings ◽

Filler Injections ◽

Soft Tissue Filler ◽

Males And Females ◽

Orbital Rim

Abstract Background Injecting soft tissue fillers into the deep plane of the forehead carries the risk of injection related visual compromise due to the specific course of the arterial vasculature. Objectives To investigate the 2- and 3-dimensional location of the change of plane of the deep branch of the supratrochlear and supraorbital artery, respectively. Methods A total of 50 patients (11 males and 39 females, mean age: 49.76 (13.8) years, mean body mass index of 22.53 (2.6) kg/m 2) were investigated with ultrasound imaging. The total thickness, and the distance of the arteries from the skin and bone surface were measured using a 15-7 MHz broadband compact linear array transducer. Results The deep branch of the supraorbital artery changed plane from deep to superficial to the frontalis muscle at a mean distance of 13 mm [range: 7.0 – 19.0] in males and at 14 mm [range: 4.0 – 24.0] in females and for the deep branch of the supratrochlear artery at a mean distance of 14 mm in males and females [range: 10.0 – 19.0 in males, 4.0 – 27.0 in females} when measured from the superior orbital rim. Conclusions Based on the ultrasound findings in this study, it seems that the supraperiosteal plane of the upper and lower forehead could be targeted during soft tissue filler injections as the deep branches of both the supraorbital and supratrochlear arteries do not travel within this plane. The superficial plane of the lower forehead, however, should be avoided due to the unpredictability and inconsistent presence of the central and paracentral arteries.

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Relationship Between Vertical Glabellar Lines and the Supratrochlear and Supraorbital Arteries

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa138 ◽

2020 ◽

Vol 40 (12) ◽

pp. 1341-1348 ◽

Cited By ~ 1

Author(s):

Sebastian Cotofana ◽

Michael Alfertshofer ◽

Konstantin Frank ◽

Vince Bertucci ◽

Katie Beleznay ◽

...

Keyword(s):

High Risk ◽

Soft Tissue ◽

Soft Tissues ◽

Skin Surface ◽

Surface Distance ◽

Deep Branch ◽

Superficial Branch ◽

Filler Injections ◽

Soft Tissue Filler ◽

The Mean

Abstract Background Glabellar soft tissue filler injections have been shown to be associated with a high risk of causing injection-related visual compromise. Objectives The aim of this study was to identify the course of the superficial branch of the supratrochlear and of the deep branch of the supraorbital artery in relation to the ipsilateral vertical glabellar line and to test whether an artery is located deep to this line. Methods Forty-one healthy volunteers with a mean age of 26.17 [9.6] years and a mean BMI of 23.09 [2.3] kg/m2 were analyzed. Ultrasound imaging was applied to measure the diameters, distance from skin surface, distance between the midline, distance between vertical glabella lines, and the cutaneous projection of the supratrochlear/supraorbital arteries at rest and upon frowning. Results The mean distance between the superficial branch of the supratrochlear artery and the ipsilateral vertical glabellar line was 10.59 [4.0] mm in males and 8.21 [4.0] mm in females, whereas it was 22.38 [5.5] mm for the supraorbital artery in males and 20.73 [5.6] mm in females. Upon frowning, a medial shift in supratrochlear arterial position of 1.63 mm in males and 1.84 mm in females and of 3.9 mm in supraorbital arterial position for both genders was observed. The mean depth of the supratrochlear artery was 3.34 [0.6] mm at rest, whereas the depth of the supraorbital artery was 3.54 [0.8] mm. Conclusions The hypothesis that injecting soft tissue fillers next to the vertical glabellar line is safe because the supratrochlear artery courses deep to the crease should be rejected. Additionally, the glabella and the supraorbital region should be considered as an area of mobile, rather than static, soft tissues.

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