TABLE 2.

Pearls and pitfalls in the use of nonconsumable dermal fillers

Treat filler injection as a surgical procedure; prep the skin as you would for a surgical procedure.

Avoid filler injections when the patient has any active inflammatory process in the treatment area, such as sunburn, active acne, inflammatory seborrhea, herpes simplex virus eruption, etc.

Photograph, mark treatment areas and consider lidocaine injections prior to placement of filling agent for patient comfort.

Recognize that acne scarring can distort the anatomy of tissue planes (dermis, fat, muscle). For instance, the dermis may atrophy and sit on the subcutis in some patients, but in other patients, the dermis may be thick and heavily fibrosed. Be aware of nerves and vasculature in the treatment area.

The risk of granulomas and nodules is very small. Granulomas are a distinct histological event. Not every bump or nodule is a granuloma.

Correct to optimal surface contour or slightly under-correct; it is easy to use a secondary injection later, if needed.

Swelling may occur within the treatment area. If clinical evaluation is obscured, consider a “time out” from injection for 10 to 15 minutes, use cold packs to reduce edema and if unsuccessful, consider rescheduling injections at a later date.

Ask patients to gently massage the injection sites for two minutes each morning and night for one to two weeks to help maintain even distribution of the microspheres within the treatment area(s).