Injectable Fillers Guidelines

Updated: Jul 14, 2022
  • Author: Deborah Yu, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Guidelines Summary

In 2021, the American Society for Dermatologic Surgery published evidence-based recommendations on the prevention and treatment of adverse events from injectable fillers. These included the following recommendations for reducing the risk of vascular occlusion from filler injection [35] :

  • A thorough knowledge of facial anatomy as well as of blood vessels and their cutaneous landmarks is necessary, as is awareness that there can be vascular variability
  • An awareness of locations with a greater blindness risk, including the glabella, medial brow, nose, forehead, superior nasolabial fold, and medial tear trough, is necessary
  • In places where arteries are located on bone, injection deep on preperiosteal planes should not be performed; such areas include the medial brow and glabella (supratrochlear and supraorbital arteries), medial canthus/tear trough (angular artery), medial cheek (infraorbital artery), and antegonial notch of the jawline (facial artery)
  • Use of a 25G blunt-tipped cannula (or larger cannula) should be strongly considered in locations where this is possible
  • Injection should be performed slowly, with low plunger pressure and with small volumes employed with each pass, while the cannula or needle is kept moving
  • Pretreatment informed consent should be obtained with regard to “the rare possibility of intravascular injection, tissue necrosis, blindness, stroke, and the emergent use of hyaluronidase”