FPSAM - Roundtable 2021 - 8

EXPERT PANEL DISCUSSION
and even with an expert understanding of anatomy,
which I have, one cannot 100% remove the risk of
complication.
Dr. Dayan: Do you aspirate before you inject?
Dr. Fabi: It depends on the product; if it means one
less side effect or one less intravascular necrosis, then
yes-when I'm using a needle, I do aspirate for at least
10 seconds.
Dr. Dayan: Dr. Rosengaus, knowing that experience
matters, or perhaps matters to preventing
adverse events, when you're training and you're
teaching, what do you tell someone just getting
started? Do you tell them there are certain areas of
the face that they should avoid, do you tell them
they should always use needles or cannulas? What
are your recommendations when teaching?
Dr. Rosengaus: As you know, I teach anatomy. I don't
believe in danger zones-I believe in danger layers.
We must be accurate and precise with our anatomy,
which means position but it also means depth of injection.
And that's why, in most cases, I prefer to use a
needle. It provides me with the information of where
exactly I am. Depending on if I'm touching bone or
I'm feeling some resistance to the entry of my needle
or the flow of it. It allows the injector reliable information
on safety. That's how I teach.
Dr. Dayan: Dr. Cotofana, how important is it where
we put the product, especially with regard to layers?
Dr. Cotofana: To be honest, I'm very sad to see this
current antiaspiration trend that was started by the
group from Australia and was also carried on here in
the United States by some authors. I'm very sad about
this because I'm always asking myself: if you get a
positive aspiration what are you going to do? Are you
going to still inject?
Dr. Fabi: Exactly.
Dr. Durairaj: Agreed.
Dr. Cotofana: It is a little bit tricky. If you preselect a
proper product-needle combination, then of course our
percentage of having a positive aspiration goes up.
I would argue that there is a bigger picture to all of this.
If you provide the proper combination between needle
and product, then you will see that you can have many
positive aspirations. All I will say is that there is evidence
that it is possible, with the proper measurements,
of having positive aspiration. However, there is always
some resistance to everything that comes along.
8
Dr. Dayan: Let's conclude our discussion with
one last segment on post-treatment recommendations.
What do you recommend to your patients?
Dr. Rosengaus, what is your general protocol for
patients after you treat them?
Dr. Rosengaus: The main concern is about the posttreatment
edema. We inform the patient of this and we
ask them to send us a selfie 6 hours later and 24 hours
later to evaluate any additional post-treatment recommendation.
Normally a little bit of ice after and a
painkiller, if they do have pain, is the only thing necessary.
It is very rare. If there is bruising, wewould give
them arnica, it could be in cream or taken orally, and
that's it.
Dr. Dayan: Dr. Fabi, what are your recommendations
for patients when they ask to apply makeup
post-treatment? And how important is this aseptic
technique to you along with the rest of your posttreatment
protocols?
Dr. Fabi: We wipe them down with alcohol and then
we wipe them down with Hibaclens. I do discourage
them from using makeup post-treatment, and we
usually like to also now give them clean masks when
they leave. I usually discourage them from applying
their makeup for at least an hour afterward, not that I
am aware of any studies showing that there is a
timeline between makeup and perhaps a delayed onset
of a granuloma formation. I think the most notable
thing that I do is I discourage patients from undergoing
any dental work for at least a month before they come
in or a month after they come in for fillers.
Dr. Dayan: Dr. Durairaj, can you also comment on
your protocols along with vaccinations, and notjust
the current COVID-19 vaccination but do you
change your post-treatment protocols because of
vaccinations?
Dr. Durairaj: We have been asking everybody to wait
at least 2 weeks after vaccination, so as to avoid any
inflammatory triggers for the body, and I think that that
is reasonable for any type of vaccinations, and about at
least 2 weeks for dental procedures as well. And if
people are leaving the office, we recommend waiting an
additional 2 weeks before getting vaccinated. If they've
already had COVID-19, I definitely would require at
least 2 months before they can do any kind of treatment
and negative testing to make sure they don't have any
active levels of virus.
I will also just mention that I'm a big proponent of
lymphatic massage post-treatment. I think one of the
most important things patients should do when they
leave after an injectable is tojust gently massage the face
ª 2021 by American Academy of Facial Plastic and Reconstructive Surgery, Inc.
FPSAM - Roundtable 2021

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