Table 2.

Recommendations for Minimizing the Chance of Embolic Phenomena (After Visual Consensus Paper⁹ 2020)

Recommendations
1. Understand the safest depth of injection in any given area
2. Inject VERY slowly and with low extrusion pressure
3. Cannulae are considered by many to be a safer alternative to needles in certain areas, including the brow, lateral, and anterior cheek. They are not considered safer for nasal injection. Smaller gauge cannulae (<25 gauge) may behave somewhat like needles in terms of their ability to pierce blood vessels.
4. Consider utilizing local anaesthetic with adrenaline at cannula entry points and within the injection field to constrict local vessels. When utilizing local anaesthetic with adrenaline, it may be worthwhile observing the patient after injection to ensure the vasoconstrictive effect resolves in order to avoid confusion with intravascular injection of filler.
5. Consider directing the needle/cannula perpendicular to primary axial vessels in the anatomical region to reduce the likelihood of vessel cannulation
6. Micro-boluses should be injected in small aliquots (<0.1 mL)
7. Move the needle in the chosen plane at all times when delivering micro-boluses, even if only in small amplitude movements
8. Consider ensuring the direction of injection is away from the eye in higher risk areas such as nose, glabella, and nasolabial fold
9. There is currently no evidence to support aspiration as a safety measure