Dr. Sam Lam Plastic Surgery Forum

On a total different sidenote... when reading of the adverse side effects of injectable fillers, some scientific papers (I do not have online access to their full texts) mention recurrent oedema or swelling. By what physiological mechanism can a filler containing something "natural" in our body (hyaluronic acid salts -is that right?) get such a response? Wouldn't the fact of being something "natural" prevent reactions to the productas if it were a "foreign body"?

And why recurrent? why do some people have it at times and not have that swelling at times? It depends on what?

Necrosis of tissue is mentioned too, if I understood it right, when linked to injecting or blocking a blood vessel. But since docs inject without "x-rays" (that I know of), how can they know when going deep into the skin (as in when injecting the cheeks,since we were speaking of it) know that they won't hit a blood vessel?

It is a bit scary!

1. recurrent swelling is usually due to the reaction to the gel carrier not to the product itself when you are dealing with legitimate versions of restylane. however, there still can technically be antigens on the HA itself that can cause a reaction even if it is molecularly identical to what is found in your body. also, if it is 1 to 2 x swelling only then the lymphatic system could be disturbed temporarily. remember the lymphatics clear the system.
2. the usual way that a doctor limits the chance of an intra-arterial injection is by pulling back on the syringe before a deep injection. if you see a flash of red, you stop, pull back and re-inject. is this a surefire guarantee? no, you could have threaded the needle through and through the vessel and hit it on the way out. all of this is extremely rare but possible. fortunately, with HAs if you start seeing this problem, you can dissolve the product immediately with vitrase (make sure your doc has this product). honestly, any doc injecting HAs should have vitrase or equivalent in their practice. i find it almost unfathomable if they don't. second, that is why i use cannulas since a cannula virtually eliminates the chance of an intravascular injection since there is nothing sharp at the tip.
best,
sml

[quote="dr. lam"]1. recurrent swelling is usually due to the reaction to the gel carrier not to the product itself when you are dealing with legitimate versions of restylane.

Makes sense!
What is usually the carrier? The restylane page did not state that info... Hypromellose (sp??)

> however, there still can technically be antigens on the HA itself that can cause a reaction even if it is molecularly identical to what is found in your body.

And then a person could not have HA injected?

> also, if it is 1 to 2 x swelling only then the lymphatic system could be disturbed temporarily. remember the lymphatics clear the system.

Oh, does it mean that some people might have their lymphatic system not working ok on a given day (say... after spending many hours working out head down?) or after crying and sleeping (since while we sleep don't drain the lympha, right?) or like when a person has aggressed by rubbing strongly an area? Then the lymphatic system might attract water/lympha to that area? Does that mean that?

It is so interesting learning from you!

Oh, and thanks for the vitrase info, I did not know that. I had no problems but I will sure ask my doc next time if he has it!!!!!
2. the usual way that a doctor limits the chance of an intra-arterial injection is by pulling back on the syringe before a deep injection. if you see a flash of red, you stop, pull back and re-inject. is this a surefire guarantee? no, you could have threaded the needle through and through the vessel and hit it on the way out. all of this is extremely rare but possible. fortunately, with HAs if you start seeing this problem, you can dissolve the product immediately with vitrase (make sure your doc has this product). honestly, any doc injecting HAs should have vitrase or equivalent in their practice. i find it almost unfathomable if they don't. second, that is why i use cannulas since a cannula virtually eliminates the chance of an intravascular injection since there is nothing sharp at the tip.
best,
sml[/quote]

actually, let me clarify terms that i have misused. HAs generally do not have carriers. Artefill and Radiesse use carriers to inject the material. however, HAs still are processed and can have some supporting agents. i have no idea what those are.

your lymphatic system is rarely disturbed but could be temporarily bothered, if you will, by the injection. don't overthink that. that's about all i can say.

Ok

great!