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

Goodman, Magnusson and Callan et al., 2021
With the rapid growth of soft tissue filler procedures, rare but serious adverse events such as intravascular injection are seen by many aesthetic practitioners. Aspiration before hyaluronic acid (HA) filler injection has long been considered a safety measure and is recommended in many consensus documents. However, its validity has recently been questioned.

Searching for the Benefit of Aspiration

Experts from Austria, New Zealand and Great Britain conducted a literature review to find out if this concept is true. Usually, the injector is in and out a blood vessel all the time during injection procedure which can result in harmless bruising. However, intravascular injection in high-risk areas can lead to severe complications like blindness.

Aspiration should no longer be Recommended

The experts could not find evidence in any study that aspiration is a reliable technique to avoid intravascular injection. Insufficient negative pressure may lead to false negative aspiration especially in smaller vessels, with quick pullback aspiration, and with thicker HA fillers. Moreover, the vessel can collapse during aspiration.

Optimizing Safety

Optimizing safety can better be obtained through deep knowledge of the facial vascular anatomy. However, vascular supply is highly variable among individuals. The authors recommend understanding the safest depth of injection in any given area and to inject very slowly, with low extrusion pressure, and in small aliquots of <0.1ml. The needle should be moved at all times when delivering micro-boluses. Cannulae are considered a safer alternative in certain areas including the brow, lateral and anterior cheek, but not for nasal injection. Using local anesthetic with adrenaline at cannula entry points and within the injection field may be helpful. Directing the needle/cannula perpendicular to primary axial vessels in the anatomical region reduces the likelihood of vessel cannulation.
The authors’ work, (Aspiration Before Tissue Filler – An Exercise in Futility and Unsafe Practice), was independently peer reviewed and published. The opinions of this literature summary are the authors and do not necessarily represent those of Merz Aesthetics.
Link to access the abstract via PubMed: https://pubmed.ncbi.nlm.nih.gov/33512439/
Link to access the full article in the journal (to read the full text it may be necessary to log in to the journal): https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjab036/6123831

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