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Blog / Injectables / Dr. DuPéré’s Rules for Safety With Injectables...

Dr. DuPéré’s Rules for Safety With Injectables

January 5th, 2020 Share

Do Not Gamble With Your Face

You may have seen and/or read about patients ending up in the ER with black (necrosed) nose, lips, or forehead after attending a BOTOX COSMETIC® party, and it recently happened again in Toronto. Often the story is one that involves a basement or a condo, on a weekend, where alcohol, food, and a “discount” are offered to tease people into going to the “BOTOX party.” Usually, this story involves “grey” credentials for the injector. It’s also a story that involves peer pressure into getting something done. Remember, the host is likely getting a “cut. At these parties, informed medical consent is rarely obtained before treatment, and antisepsis (antibacterial) techniques are infrequent. Often, no antidote is available on-site in case of an emergency.  Finally, no doctor on-site is way too common. And although “some” doctor must sign the prescription for the injectables, the doctor is often not reachable in case of an emergency.  Read this Toronto story.

How safe is BOTOX in a clinical setting?

In contrast, BOTOX injections performed in a plastic surgery practice or a medical spa setting are usually much safer. Complications do occur but are rare when injections are done carefully. Some potential complications include infections and inadvertent injection in a blood vessel and secondary obstruction of that blood vessel with its secondary loss of tissue (nose, lips, eye, forehead, etc.).  Bruising and the time “off” work required for the healing and repair to happen are also considerations.

Cosmetic injections should not be confused with a Tupperware party

Having your injections in an accredited medical and surgical clinic enhances your chances of a happy ending.  Having a plastic surgeon do your injections heightens your chance of safety and excellent results. Everyone will agree that a plastic surgeon, who is a specialist of the soft tissues, muscles, nerves, and vessels, knows more about the facial anatomy than a dermatologist, who himself/herself knows more about anatomy than a family doctor, who knows more than a nurse, who knows more an esthetician, and so on. Yes, you read it… some charlatans will have non-medical personnel doing your injections.

The products used may also not be the best.  Some products can be bought on the “black market.”  Some unscrupulous injectors have used toxins for animal-use-only—remember the Florida event several years ago where 4 patients ended up in the ICU for 3 months because the concentration for animal use is much much higher than for human use?

Some injectors use Home Depot “0ff-the-shelf” non-medical-grade products for injections. There are so many examples in the news. Not only is this practice unethical and dangerous, but it is often associated with permanent problems. We plastic surgeons are often called upon to deal with and repair those permanent issues several years later.

One fact patients don’t know: some fillers are better than others, and the cost will reflect that.

The various toxins such as BOTOX and Dysport come to us doctors as a powder, which we must reconstitute with a sterile solution. This means you have to trust your injector to use the right and honest recipe and not “dilute” the medication.

As for infections, they are rare and usually avoidable. A few years ago, I decided to treat my injectable procedures the same way I do my surgeries. I follow the sterile technique to the “knot.”  Although this is not yet the “standard of care” in the injectable community, it is the VISAGE Clinic’s standard of care.

The VISAGE Clinic and Dr. DuPére’s Injectables Standard of Care

1. We always wear sterile gloves when injecting BOTOX, Dysport®, and dermal fillers.

2. We use the cannula techniques whenever possible.

3. A thorough cleaning and removing of the makeup is mandatory. It’s best for patients to come without make-up, if possible. (Make-up has been shown to contain a long list of bacteria.)

4. A proper cleansing of the skin at all contact point with the injector is performed with an antiseptic agent: 1% chlorhexidine is a good option, the same solution we use for facelift, rhinoplasty, eyelid lift, etc.

5. If using a topical anesthetic cream, the antiseptic cleansing occurs after the topical cream is removed.

6. We all “dab” bleeding points with gauzes… so we use sterile gauzes at VISAGE; I personally use those and will dip them into chlorhexidine for my use during the injections.

7. I always bathe the perforating needles and cannula in chlorhexidine antiseptic solution.

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VISAGE Clinic and MedSpa Toronto Plastic Surgeon Dr Marc DuPéré injecting a patient.

8. We use perforated sterile drapes exposing the face only, as one does for all types of surgery (“draping”), avoiding contact with hair which cannot be asepticised; those drapes are custom-made for VISAGE.

9. If going through the BOTOX/Dysport grey rubber cap, an alcohol swab is always used. If removing the cap, as the rubber cap can “dull” the needles (and then it is more painful for the patients), care should be given to not contaminate the lid itself and to keep the bottle open as short a time as possible.

10. Strict avoidance of creams and make-up post procedure–I recommend a minimum of 1 hour to my patients prior to reapplying make-up; I think this is a very important point to minimize risk of infection.

11. When preparing several needles at once (eg. for glabella, mentalis, forehead, platysma, etc.), we make sure that the needle tip won’t touch any non-sterile surface and that it is not exposed to the exterior elements for more than a few minutes. I know several practitioners prepare many needles and store them for the day in the fridge, often uncapped; this should be discouraged.

12. All open and reconstituted BOTOX is used relatively quickly.

13. The bottle for the reconstituting agent is also handled sterilely, and the syringe and needle used for reconstitution are discarded after every single use and not “stored” for later in the day for the next bottle.

With this protocol, our patients obtain beautiful results and we keep our complications very close to zero.

Our careful attention to the safe administration of BOTOX creates excellent results with minimal risks. You can see some of our patients’ dermal filler results in our before-and-after photo gallery. And if you’re ready to see how BOTOX and Dysport can help smooth crow’s feet and other wrinkles, contact us online to request an appointment or call us at (416) 929-9800.

Dr. Marc DuPéré, aesthetic plastic surgeon and solo injector at VISAGE.