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Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice

Goodman, Greg J; Magnusson, Mark R; Callan, Peter; Roberts, Stefania; Hart, Sarah; Lin, Frank; Rahman, Eqram; ... Clague, Michael; + view all (2022) Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice. Aesthetic Surgery Journal , 42 (1) pp. 89-101. 10.1093/asj/sjab036. Green open access

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Abstract

Background: Aesthetic physicians rely on certain anecdotal beliefs regarding the safe practice of filler injections. These include a presumed safety advantage of bolus injection after a negative aspiration. Objectives: The authors sought to review and summarize the published literature on inadvertent intravascular injection of hyaluronic acid and to investigate whether the technique of aspiration confers any safety to the practitioner and the patient. Methods: Pertinent literature was analyzed and the current understanding of the safety of negative and positive aspiration outlined. Results: The available studies demonstrate that aspiration cannot be relied on and should not be employed as a safety measure. It is safer to adopt injection techniques that avoid injecting an intravascular volume with embolic potential than utilize an unreliable test to permit a risky injection. Conclusions: To prevent intravascular injection, understanding "injection anatomy"and injection plane and techniques such as slow, low-pressure injection are important safety measures. Assurance of safety when delivering a bolus after negative aspiration does not appear to be borne out by the available literature. If there is any doubt about the sensitivity or reliability of a negative aspiration, there is no role for its utilization. Achieving a positive aspiration would just defer the risk to the next injection location where a negative aspiration would then be relied on.

Type: Article
Title: Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/asj/sjab036
Publisher version: https://doi.org/10.1093/asj/sjab036
Language: English
Additional information: © 2021 The Aesthetic Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10169482
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