DO NOT GAMBLE WITH YOUR FACE.
You may have seen and/or read years after years about patients ending up in the ER with black (necrosed) nose, lips or forehead. Again a few months ago 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”. A story that involves “grey” credentials for the injector. A story that involves peer pressure into getting something done – remember, the host is likely getting a “cut”. The story usually involves that no informed medical consent was obtained. No antisepsis (antibacterial) techniques are being used. Often no antidote is available one site in case of 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 emergency. Read this Toronto story.
Complications do occur but are rare when done carefully. Infections, inadvertent injection in a blood vessel and secondary obstruction of that blood vessel with its secondary loss of tissue (nose, lips, eye, forehead, etc.), not mentioning the bruising and the time “off” work required for the healing and repair to happen.
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 heightened your chance of safety but also of 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… Yes, your read it… some charlatan places will have non-medical personal 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 ICU for 3 months because the concentration for animal use is much much higher than for humans use.
Some injectors use Home Depot “0ff-the-shell” non-medical grade products for injections. So many examples in the news. Not only this practice is unethical and dangerous, but it are often associated with permanent problems. We, plastic surgeons, have to deal with 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… which means you have to trust your injector in doing the right and honest recipe and not “dilute” the medication.
As for infections, there are rare but are usually avoidable. A few years ago, I decided to treat my injectable procedures the same way I do with my surgeries: I follow the sterile technique to the “knot”. Although the – yet – “standard of care” in the injectable community, it is the VISAGE Clinic’s standard of care.
Here is VISAGE Clinic and Dr DuPéré’s standard of care when performing injectables.
1. We always wear sterile gloves when injecting botox, disport and fillers
2. We use the cannula techniques whenever possible
3. A thorough cleaning and removing of the makeup is mandatory; best for patients to come without make-up if possible (make-up has been showed to contained 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 gauges 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
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 aways 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 preparing many needles and storing them for the day in the fridge, often uncapped; this should be discouraged
12. All open and reconstituted Botox are used relatively quickly
13. The bottle for the reconstituting agent is also handled sterilely and the syringe and needle used for reconstitution is 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.
Dr. Marc DuPéré, aesthetic plastic surgeon and solo injector at VISAGE.