Complications, aesthetic ultrasound & dissolving
​There's a lot of confusing and conflicting information on social media regarding the complications management of injectables. Most patients have a lot of questions including:
- Who is the best person to treat these types of issues?
- What actually happens when products are injected into the tissues of the face?
- How long do these products last?
- What is the role of aesthetic ultrasound and when is it needed?
- What happens to your face and skin when fillers are dissolved?
- What are the risks of using filler dissolving products?
If you're wanting a second opinion from Dr Jake regarding managing a complication from another injectors work, please read the information on this page carefully and then complete the form at the bottom of the page. Dr Jake will then triage your enquiry and get back to you if he can help.
Filler dissolving isn't suitable for all products or all situations. Without the right information to make a judgement call, Dr Jake will politely decline seeing you.
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Why is managing complications so tricky?
Patients often lose trust with their previous injector after a complication. Whilst this is understandable, complications can happen in the best injectors hands. The risks of your treatment will have been explained to you when you signed a consent form prior to your treatment and so rarely, these do happen. Therefore instead of cutting ties with your old injector, the best person to see is them.
They will know exactly what product was used, how it was injected, how much was used and what layer of the face it was placed. Dr Jake strongly advises patients with a complication to contact their treating injector as the first port of call and explain your concerns. Any reputable injector would not only be happy to see you, but it's their duty to try and help you given that they were medically and legally responsible for your treatrment.
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The role of ultrasound in aesthetics
Ultrasound has become an incredibly useful tool in Dr Jake's practice - but it is not always needed and sometimes patients get confused about what it's for.
Around 99% of injectors do not have ultrasound in their clinics and yet routinely dissolve old fillers all the time with no difficulty.
This is why you're encouraged to see your original injector first because it shouldn't require specialist help.
Dr Jake uses ultrasound for three main reasons:
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1) To help identify and avoid the main blood vessels in particular areas of the face
This is sometimes referred to as 'vascular mapping'. Dr Jake doesn't do this routinely but for specific areas of the face such as the nose, temple or deep lines close the the nose, he may scan the areas prior to considering a facial volumising treatment.​
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2) To treat filler emergencies known as 'vascular occlusions'.
If a facial volumising product is inadvertently injected into a blood vessel, this can compromise the blood supply to the skin of the area. In this scenario the product should be dissolved as soon as practically possible to avoid compromise of the blood supply of the skin. Using ultrasound is now accepted by many experts to be the gold standard in managing these complications because it can assess the blood supply of the area, visualise the areas of filler placed and help to target more precise dissolving of the product.
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2) To assess old fillers that may have become problematic or are resistant to dissolving
If an area of volumising product is older, it can sometimes get 'walled off' by scar tissue or similar. This can make it resistant to dissolving product. The old product can usually be visualised seen using an ultrasound device and this can then help plan a dissolving treatment, occasionally by targetting the area under ultrasound guidance. Ultrasound guidance is rarely needed and the best person to any dissolve old product is the injector who initially treated you
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Things to to think about before
considering a dissolving treatment
Dissolving isn't always best
In one of the latest clinical studies on this topic, approximately 20% of patients were unhappy at how empty, deflated or different the area looked after a dissolving procedure. Therefore undergoing a dissolving treatment isn't always best and the results could distress you more than the current look you have. This is a situation that should be anticipated and planned for to avoid further anxiety about how you look.
Therefore a conversion that will always be had in your consultation - sometimes having poorly placed filler is a better option than dissolving the product that will likely leave you with looser, hollower, saggier and crepier-looking skin. Dr Jake will do his best to help you make this judgement call in your consultation and be honest about what he thinks is best for you.
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Pre-dissolving MRI scans
Very occasionally Dr Jake will request that a facial MRI scan is done before considering a dissolving treatment. This is the exception and not the rule but in atypical cases, it will help Dr Jake plan for any future management. (He may also consult with some other global experts with the results of your scan including Dr Mobin Master & Dr Daniel Ezra)
The report and scan images will need to be made available to Dr Jake prior to your consultation and he will advise you how to organise this if required. Dr Jake will provide you with a referral for the scan to be done at the Mater Hospital, Sydney - you will need to go to this specific hospital where Dr Jake will then liaise with their Consultant Radiologist who has expertise in managing filler complications)
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On the day of your consultation​​​​​​​​​​​
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Dr Jake will re-explore whats happened to you and examine the areas both with photos, then hands on and an ultrasound scan will be done.
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If a dissolving procedure is indicated, this often does not need special ultrasound guidance. There are more and more patients who book for this service who think that ultrasound will be needed for accurate dissolving. This is not often true as many bumps and lumps are superficial. Whilst it can been a very useful, ultrasound is only a tool that's needed in certain situations.​ Unless the product that is very focal, very deep or very difficult to reach that warrants ultrasound guidance, it will be dissolved without ultrasound.
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It will never be possible to remove all the filler in its entirety. Filler when viewed under ultrasound is typically seen as small 'granules' that are scattered and mixed amongst your own natural tissues over a wide area. Patients wanting all of their old fillers 'removed' should not book for this service with Dr Jake. There is no guarantee of achieving this and this is not an indication that Dr Jake offers ultrasound for.
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Costs
Regarding costs, the new TGA laws prohibit clinics from quoting prices to patients who haven't yet had a consultation. This is frustrating but we have to abide by the law.
To repeat, Dr Jake strongly encourages patients to contact their original injector as the first port of call as they may well help you as a complimentary part of their ongoing service to you as their original patient.​​​​​​​​​​​​​
Key features of aesthetic ultrasound & filler dissolving
Consultations
New patient filler consultations = 60 mins
(This includes the consultation, ultrasound examination +/- dissolving)
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Improving safety
Even the best injectors will experience complications - they are medical procedures. But embracing technology like ultrasound can help reduce the risk of vascular occlusions and blindness.
Accurate dissolving
We now know that the most commonly used fillers will remain in our tissues for 10+ years. If problematic, they can usually be seen using ultrasound to help plan a dissolving treatment.
Emergency treatments
Injectors without experience in treating vascular occlusions will often struggle to locate the problem area. Ultrasound can help make filler dissolving quicker and reduce harm to patients.
Downtime & aftercare after aesthetic ultrasound & filler dissolving
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Some swelling or tenderness at the injection sites is very normal. This can take a few days to recover.
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Bruising is possible after a dissolving treatment and for the lip area this can sometimes be extensive.
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After dissolving fillers (and particularly ones that have been in the tissue for a long time), visible hollowing, 'emptiness' and sagging of the area can occur. It can be distressing to look more tired, empty or saggy.
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There is no evidence that filler dissolving affects the natural tissues of the face at all. Dr Jake is aware that this is sometimes claimed on social media but there is no proof of it to date
Please complete this form for
any complication enquiries
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How do wrinkle treatments work?Wrinkle treatments are performed using tiny injections. They work by temporarily and reversibly blocking nerve signals to specific areas of the facial muscles, allowing the muscles to relax. As a result, the skin overlying the muscles also relaxes, smoothing out the visible lines. Over a period of on average 4 months, the treatment wears off and wrinkles slowly return.
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How should I prepare for my wrinkle treatment?As for all injectable treatments, please come with no make up, foundation or similar on your skin. This will reduce the risk of an infection. To reduce the risk of bruising: - avoid alcohol for 24 hours prior - stop any fish oil supplements at least 5 days prior - stop any garlic, ginger, gingko biloba or ginseng in high doses - avoid any anti-inflammatory medicines (neurofen, ibuprofen, naproxen, etc) for 5 days before your treatment if possible. Prescription medicines that can make bruising much more common include warfarin or other anti-coagulants. If these are prescribed by your GP, it's not recommended to stop them. You can still have injectables but you should expect bruising to be much more common and obvious.
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What can't I do after a wrinkle treatment?You can go back to your normal daily activities after a treatment except for two simple rules: 1) Don't massage, rub or wash the areas injected until the next day after your treatment. This also includes not doing things like having a massage, facial or similar straight after an anti-wrinkle treatment. (for at least 12 hours afterwards) 2) Avoid sports, exercise or vigorous activity for 12 hours afterwards. These rules help prevent the anti-wrinkle product spreading and affecting other muscles of the face that we don't want to treat. Failure to follow these increases the chance of complications, most importantly eyelid or eyebrow drooping. These are both avoidable and reversible side effects but can take several weeks or even months to settle. Avoiding alcohol after any injectable treatment until the following day also reduces your risk of worsened bruising.
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What are the potential side effects?The most common side effects include: - Mild discomfort during the procedure - very temporary swellings and redness (that disappear within minutes) - bruising (always a risk when a needle is used) Rarer side effects include: - In less than 1% of cases, patients can very rarely experience eyebrow or eyelid heaviness (called a 'ptosis'). This is very rare, temporary and often resolves in three or four weeks on it's own. This might be caused by a failure to follow the after care rules described above. In this scenario, some special eyedrops might be prescribed to you to help lift the heavy eyelid but you'll need to be reviewed in person first.
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Do wrinkle treatments hurt?The injections only take minutes to perform and no special measures are needed. Dr Jake uses the smallest needles available and most patients are pleasantly surprised at how easy the process is.
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Are there any people who shouldn't have a wrinkle treatment?There are just a few but important conditions that are contraindications to wrinkle treatments: - Pregnancy or breastfeeding. (Patients trying for a baby, undergoing IVF or who are unsure if they are pregnant will also be refused treatments) - Rare neurological diseases such as Myasthenia Gravis Those taking the following medicines should also not have these treatments: - Aminoglycoside antibiotics (Gentamycin, Neomycin, Streptomycin, etc) - Penicillamine (used to treat Rheumatoid Arthritis) - A known allergy to human albumin A detailed medical history will be taken prior to your treatment but it is your responsibility to declare any medical problems to us in good time.
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How often should I have treatments?If the recommended dose is done on the day of your treatment, the results will last 2-4 months on average. Most people therefore come every 3-4 months to help maintain a consistent appearance.