CONSULTATIONS FOR COMPLICATIONS

If you're a patient wanting an opinion about a complication, think you may need an ultrasound assessment or product dissolving , you must be referred by your treating injector and they need to complete the form below. Patients cannot refer themselves.

Dr Jake will triage the enquiry and get back to your injector if he can help.

WHY DR JAKE REQUESTS REFERRALS

Patients often lose trust in their injector after experiencing a complication. Whilst this is understandable, complications can and do happen, even in the best injectors hands. The risks of your treatment should have been explained to you when you signed a consent form prior to your treatment - and so rarely bad outcomes can and do occur.

Instead of cutting ties with your original injector, the best person to seek help from is them. They will know exactly what product was used, how much they added, what layer of the face it was placed and so o. Any reputable injector should be happy to see you and it's their duty of care to try and help you.

Dr Jake will only consider seeing patients after their injector has tried to resolve the situation themselves.

MORE ABOUT COMPLICATIONS

There's a lot of confusing and conflicting information on social media regarding the aesthetic complications management. Most patients have a lot of questions including:

- When and why should products be dissolved?

- Who is the best person to treat these types of issues?

- Are aesthetic medicines safe?

- How long do products last and can they dissolve naturally?

- What is the role of ultrasound and when is it needed?

- When do I need an MRI scan of my face?

- What happens to the tissues of the face and skin after dissolving is done?

- What are the risks of using dissolving products?

THE ROLE OF ULTRASOUND IN AESTHETICS

Ultrasound has become a useful tool in Dr Jake's practice but patient's don't always understand what it's used for, nor when it has less relevance. Around 99% of clinics do not have access to an ultrasound device. Despite this, they have routinely dissolved product with little difficulty. This is why you're encouraged to see your original injector first because it often doesn't require specialist imaging or expertise. That said, Dr Jake uses ultrasound for three main reasons: 1) To assess areas 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. Older products can be harder to visualise even with an ultrasound device but it is a non-invasive means of assessing chronic issues. In certain circumstances, the area material can also be targetted under ultrasound guidance. 2) To treat aesthetic emergencies known as 'vascular occlusions'. If a 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 area and help to target more precise dissolving of the product. It is a difficult skill to master but Dr Jake has some experience in this. 3) 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 elect to scan the areas prior to considering a facial volumising treatment. Even with an ultrasound imaging, no guarantees are given for 'safe' injecting.

WHAT TO KNOW BEFORE CONSIDERING DISSOLVING

Pre-dissolving MRI scans: Dr Jake will occasionally request that a facial MRI scan is done before considering seeing a patient for a complication consult. This isn't a black and white rule but in certain cases or where dissolving has already been attempted, it will pinpoint lingering problematic product that should be targeted. In this circumstance Dr Jake may consult with other global experts with the results of your scan including Dr Mobin Master based in Gold Coast, QLD. 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 so that the correct MRI protocol is done. 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 areas looked after being dissolved. Therefore undergoing a dissolving treatment isn't always the best option 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 about this will be had in your consultation with Dr Jake. Occasionally on balance it might be better having poorly placed filler 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. On the day of your consultation Dr Jake will re-explore what happened in your previous treatment/s and examine the areas with photos, hands on and an ultrasound scan will usually be done. If a dissolving procedure is indicated, this doesn't always need special ultrasound guidance. More and more patients who seek complications management request for it to be done under ultrasound guidance in the belief that is it required and more accurate. This is not necessarily true and each situation will be managed on it's merits. Whilst ultrasound can useful, is only an 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 usually be dissolved without ultrasound. It will never be possible to remove all the filler in its entirety. Filler when viewed under ultrasound is typically seen as tiny '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 as it;s simply not realistic nor necessary. There is no guarantee of achieving this whatsoever and therefore Dr Jake doesn't see patients wanting this 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. Dr Jake again strongly encourages patients with complications to contact their original injector as the first port of call. They may be able to help you as a complimentary part of their ongoing service to you as their original patient.

DOWNTIME & AFTERCARE AFTER
A DISSOLVING PROCEDURE

Some swelling or tenderness at the injection sites is very normal. This can take a few days to recover.

Bruising is possible after a dissolving treatment and for the lip area this can sometimes be extensive.

After dissolving, visible hollowing, 'emptiness' and sagging of the area can occur. It can be distressing to look more tired, empty or saggy.

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

REFERRAL FORM FOR INJECTORS

Patients first name

Patient's last name

Patient's email

Patient's date of birth

Day

Month

Year

Name of the referring clinic and injector

Please summarise what has happened & what your concerns are?

What product/s was used and how much was injected? (If a non-dissolvable product was used, Dr Jake does not see these referrals)

List the patients full aesthetic history from oldest to most recent including any previous dissolving or complications

What is the specific reason for the referral? (Dr Jake will consult +/- ultrasound scan +/- dissolve and then hand the patient back to your care.

Please summarise the patients medical history:

And in particular was there a specific rigger to their current filler issue?

Do they have any history of allergies including to bee/wasp stings?

To speed up the triaging process please take a selfie video on your phone of the area that you are concerned about and explain in the video what the issue is

I agree to supply the patient with a copy of the clinical notes of my treatment/s

I accept that Dr Jake may not be able to help rectify the complication

I will not hold Dr Jake medico-legally responsible for a pre-existing complication

I consent for Dr Jake to discuss the case with other global complications experts if needed

I agree to organise a facial MRI prior to the consultation if Dr Jake recommends it (he will explain how to do this)

Please sign below

Signature field is empty.