Complications in facial aesthetic treatments: Botulinum Toxin & Dermal Filler

Non-surgical facial aesthetics treatments continue to rise in their popularity. Injectables were a £1.4billion industry in Europe last year: a 17.3% increase compared to the previous year. There are hundreds of thousands of people undergoing these treatments annually and it’s a lot closer to home than you think!

Starting out in a new field can be both exciting and terrifying. A commonly occurring fear that practitioners have which stops them from venturing out into the field of aesthetics is the fear of encountering complications and not being able to manage them. At the London School of Facial Aesthetics our goal is to empower our delegates to provide facial aesthetics treatments safely with a comprehensive knowledge of recognising and managing complications. This is why we have introduced our comprehensive complications management online masterclass. Find out more here: https://www.thelsfa.com/courses-book-now/dermal-filler-courses-ngsnj

As healthcare professional we do our utmost to look after our patients holistically and above all: do no harm. Therefore it is paramount to ensure your aesthetics training is comprehensive and there is emphasis on complications management. This is the reason that we have developed our comprehensive complications management online masterclass empowering delegates with the knowledge and skill to identify and manage aesthetics complications.

As with any treatment, facial aesthetics treatments come with their own set of possible complications and we are going to discuss some of these.

Botulinum toxin complications:

Any treatment that breaches the skin barrier has the potential to cause complications listed below and treatment with botulinum toxin is no exception. These include:

·      Bruising

·      Swelling

·      Excessive bleeding

·      Oedema

·      Haematona

·      Infection

As always, we would check the medical history to ensure we are aware of any pre-existing conditions that may increase risks of excessive bleeding or bruising and manage these appropriately.

Infection is very unlikely as we follow strict aseptic techniques.

Complications which may relate to injection technique include:

Brow ptosis (medial or lateral)

Eyelid ptosis

Complications relating to injection technique are usually unilateral and transient in nature and will usually start to wear off when the muscles return to full strength or even slightly prior to this.

Medial brow ptosis could be due to treatment of frontalis without treatment of the glabellar complex and it can be corrected with further toxin treatment.

Lateral brow ptosis could be due to treatment of the lateral frontalis without treatment of the orbicularis oculi (muscle responsible for the appearance of crow’s feet). This could also be managed with further toxin treatment.

Eyelid ptosis can occur due to poor injection technique (injections are too deep and too close to the orbit) or due to spread of toxin to the levator palpabrae superioris muscle which is in charge of keeping the eyelid lifted. Inadvertently treating this muscle with toxin will cause the eyelid to droop and can obstruct the patient’s vision. We therefore need to manage this until the toxin starts to wear off. Management includes advising use of 0.5% aproclonidine eye drops three times a day as a temporary solution. This will stimulate the superior tarsal muscle to improve the presentation of the eyelid ptosis until toxin starts to wear off.

Dermal filler complications:

Dermal filler complications can be grouped according to the time of appearance.

Immediate:

Anaphylaxis

Bleeding, bruising and other injection site reactions

Skin changes/vascular events

Early:

Infection

Swelling and oedema

Nerve damage

Placement related (non-inflammatory nodules, asymmetry/overcorrection, Tyndall effect)

Delayed:

Hypersensitivity-related swelling/oedema

Inflammatory nodules including granuloma

Late chronic infection

Product migration

Anaphylaxis reactions to hyaluronic acid based dermal fillers are very rare due to the high biocompatibility and biodegradability. However most dermal fillers contain lignocaine which can elicit an immune response.

Bruising after dermal filler treatment is a common side effect and can be quite pronounced. It is important to rule out a vascular occlusion as the appearance can sometimes be similar.

Infection is rare as we follow strict aseptic protocols. Herpetic infections can occur for example following lip augmentation treatment with dermal filler, in particular if there is a previous history of cold sores.

Swelling and oedema are very common especially in the first two weeks after treatment. These can be managed conservatively and if there is no resolution after around 2 weeks, we may need to consider dissolving the filler.

Delayed Onset Nodule (DONs) formation can be inflammatory and non-inflammatory and can be due to poor injection technique or poor product choice for the area being treated.

Poor placement issues such as Tyndall effect can occur if the product is placed too superficially and filler migration can occur if the filler is displaced to an area remote to the intended area of injection. Conservative management such as firm massage within 14 days of treatment is advised and if there is no resolution following this, we may consider dissolving the filler.

A vascular occlusion is a rare but serious complication and can occur due to partial or complete obstruction of an artery. This will cause pain and darkening of the skin as well as tissue ischaemia and resulting hypoxia. There is usually instant severe pain, however this may be masked by anaesthetic present in the filler. Capillary Refill Time (CRT) can be a useful parameter to assess tissue perfusion.

A retinal vascular occlusion refers to blockage of the retinal artery which can result in a lack of oxygen delivery to the retina and resulting ischaemia and visual loss. Prognosis is poor and recovery of vision is rare.

Being aware of managing complications that can arise as a result of facial aesthetics treatments is paramount in providing these treatments safely and providing the best level of care for our clients.

To find out more about managing facial aesthetics complications or to sign up for our complications masterclass please visit our website https://www.thelsfa.com or email us at info@thelsfa.com.

Instagram: https://www.instagram.com/the_lsfa/?hl=en-gb

Facebook: https://www.facebook.com/The.London.School.of.FacialAesthetics/

Why dentists are ideally suited to provide facial aesthetics treatments:

With the rise of social media and celebrity culture, more and more people are turning to non-surgical treatments to tweak their appearance. These treatments include anti-wrinkle treatment of commonly treated areas such as forehead, smile lines and frown lines as well as volume enhancement of the lips and cheeks with dermal filler.

According to marketresearch.com the facial aesthetics market size was valued at £4.6 billion in 2021 globally and is estimated to reach a staggering £19.3 billion by 2029. This shows that this is a huge market which is set to continue to grow exponentially in the future.

Many dentists have opted to provide facial aesthetics treatments to clients either alongside their dentistry or even altogether instead of dentistry and here is why.

• Dentists have a comprehensive knowledge of the facial anatomy which is the solid foundation for providing facial aesthetics treatments

• We are very comfortable with injecting the face- we start learning this from early years at dental school which is unique even compared to our medical colleagues. We see this time and time again on our courses where dentists are naturally much more comfortable injecting compared to other healthcare professionals.

• We are trusted by our patients and can start introducing these additional services to our existing patients. Having these treatments can feel daunting and patients feel much more at ease if their existing trusted healthcare professional who they see regularly and have built a rapport with over time can provide these treatments for them.

• We have the appropriate training to be able to deal with any complications and medical emergencies that may occur.

• We have an aesthetic eye and are able to analyse the face and plan suitable treatments accordingly. We have been trained to understand and analyse facial proportions and asymmetries. Now we can correct them with minimally invasive non-surgical treatments.

• We can use botulinum toxin and dermal fillers in our smile design treatments to enhance the end result. For example, we can improve gummy smiles using botulinum toxin. We can camouflage the appearance of a retrognathic mandible using dermal filler.

As dental professionals, we commit to a lifetime of continuous professional development and offering these treatments to patients allows us to offer holistic treatment options to patients so that they are aware of all alternative treatment options that are available to them. For example, at dental school we learn about orthognathic surgery to correct malocclusions with an underlying skeletal discrepancy. In reality, we’ll often find that adults who may benefit from orthognathic surgery may not wish to have this comprehensive treatment due to the downtime and invasive nature of the procedure. Instead, they may opt for a non-invasive alternative that may improve their current situation with compromised aims. It is very beneficial for dentists to be able to have the knowledge and skill to discuss non-surgical alternative treatment options with these patients. Of course, every case is unique and needs to be assessed on its own merits, however it is important for us to be able to discuss a comprehensive list of treatment options for the patient so that they can decide what is the most suitable choice for them.

Providing these treatments can be an additional source of income for dentists and an enjoyable alternative to the dental treatments they offer. You’ll often find that your friends, family and colleagues will be the first to request you treat them and this is a great way to practice your new skills and get more and more comfortable in order to treat your other clients.

A beginner’s guide to facial aesthetics

Are you interested in learning about aesthetics but don’t know where to start from?

Starting out in the world of aesthetics can be daunting; we know, we have been there! Even though the market for Botox & Dermal Fillers has massively grown in the last years (and will continue to grow!), there is a large number of people who do not come in contact with the world of aesthetics on a day to day basis. This can make it feel overwhelming as you literally won’t know where to start from.

Here are some of the most common questions we come across from our beginner delegates.

What is the difference between Botox and Dermal Fillers?

Botox or Botulinum toxin type A is a neurotoxin that is naturally found in lakes, forests and soil. It can be injected into certain facial muscles to temporarily slow down and relax their movement. This results in softening of any lines & wrinkles that form when we move those muscles, such as when we smile, frown or raise our eyebrows. It works wonders on wrinkles that can only be seen when we are moving those muscles (dynamic wrinkles)! However, if we leave it too long and those lines have really etched into the skin and are present even when we are not smiling or frowning (static wrinkles), then treatment will be a lot less effective.

Dermal Fillers are either collagen or synthetic materials that we inject into the dermis to augment, contour or volumise the soft tissues. The most commonly used dermal fillers are those made of hyaluronic acid. They are a great option for ‘filling in’ static wrinkles, giving back volume that has been lost around the face due to the ageing process or contouring and reshaping certain areas of the face such as the nose or chin.

I know nothing about aesthetics, where do I start from?

We know how daunting and strange it feels when you want to dip your toes into unknown territory! That is why we have designed our courses to take you through from the very basic principles & applications of Botulinum Toxin and Dermal Fillers all the way to becoming an advanced and confident practitioner. We recommend starting with our Basic & Advanced 2 day course, followed by bespoke masterclasses tailored to your learning and experience. We provide you with post course support and guidance to give you all the information needed to become a successful aesthetic practitioner.

Will I learn everything on the 2 day course?

You will learn everything you need to start your aesthetic career; you will be confident in your theoretical knowledge of injectables, the anatomy of the face, the pros and cons of injectables, how to deal and prevent side effects and how to safely inject clients.

Will I be ready to inject straight after a course?

Yes! You will get plenty of practical experience on the course, by injecting different areas and observing your colleagues inject.

Students who attend our training will leave confident in learning

• The correct injection techniques and indications

• Facial Anatomy relevant to injectable treatments

• The different products available and how to choose the most appropriate one for your patient

• How to decide on the right dosage for your patient

• How to properly assess your patients needs

Our Basic & Advanced Botulinum Toxin and Dermal Filler Courses

Each course is divided in two parts. The first part of the training is the theoretical side of the course. This training covers both basic and advanced material, focusing on anatomy and medicines as well as the techniques you will then use during the practical training. The second part of the training, is the practical training. During the practical training, we work with real clients in a clinic-style setting.

We believe in small group teaching so that you can have as much injecting time as possible. This allows you to confidently practice the skills learned and apply your theoretical knowledge. 

Aesthetics trainings is a wonderful opportunity to introduce an exciting dimension to your career, expand your practice and skillset and increase your revenue.

Follow the link below to kickstart your career in aesthetics today;