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  • It is currently Fri May 24, 2013 2:25 pm

Avoiding injecting into blood vessels

section of the forum is dedicated to discussions addressing injectable fillers including Restylane, Perlane, Juvederm, Radiesse, Sculptra, Silicone, Artefill, or other office-based injectable filler, except for the management of acne scarring (See Acne/Acne Scarring Forum).
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Avoiding injecting into blood vessels

Postby Mysteryagain » Thu Jan 07, 2010 2:13 pm

Hi there! Happy New Year! Hope you spent wonderful Holidays, all of you! I have been away and before that, hyper busy. This past year has been particularly crazy, hope the new one is calmer and allows me to have more time to chat with you all.

Dr., you have often brought up the issue of the need to have certain substances to prevent major problems when injecting fillers. I know there are many posts that mention that, but would like to review the matter without it being linked to one specific case.

I am talking of this because of what happened in the past month with an Argentinian model, an ex Miss, who had PMMA injected in her butt to make it bigger/better (gosh, how much PMMA is needed for that?!), but as the PMMA got into a blood vessel (I think that is the explanation that was given), it traveled to the lungs and caused an embolia.
Scary, huh?

I suppose iti is a problem that can take place not just with PMMA but with other fillers as well. Right?

In any case, how does a doctor inject something and knows that the product is not getting into the bloodstream?

Aside the issues that could come out from having large quantities of PMMA in the body, in the LONG term or medium term, what is what you can assume (I know you can only assume, since you were not there nor saw that doctor, etc.) happened? What can a doctor do wrong to have a substance enter the bloodstream?

For any patient, is there any way to know/learn if the doctor is doing whatever can be done to check if nothing is getting into a blood vessel?

Was it for that that you said you had nitroglycerine available? and if that's the case, why and how does it work?

On a sidenote, the same procedure (and I am not saying it is safe, no) is performed everyday in countless Brazilian people and relatively speaking, there haven't been (many) problems, at most stories of necrosis of a small part of the body. Does that indicate that whomever did that procedure was particularly not careful or good at injecting a substance? or can it happen even in the hands of good doctors?

The news were really big here and are the subject of a lot of controversy! - Therefore my asking you. So I can comment on it being better informed :)
Mysteryagain
 
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Re: Avoiding injecting into blood vessels

Postby dr. lam » Thu Jan 07, 2010 6:46 pm

Hi MA,
Yes, had a great holiday. Spent it in Hong Kong for my niece's wedding. It was fantastic. First of all, I cannot and should not comment on another surgeon's case both for medico-legal reasons and ethical ones. Second, I don't do body injections and certainly not in those quantities so things can be very different with massive injections. Third, when I inject I always flash back on the syringe (pull back) to minimize the chance of having an injection into a vessel. Fourth, what you are asking about is I have nitropaste (which does not help pulmonary emboli but it helps local emboli or changes that are near the injection site). It is a vasodilator (opens the blood vessel) so that the area gets enough blood supply. With any hyaluronic acid based product, I keep Vitrase so that I can open up the blood flow immediately when I need to but that is not possible with PMMA or other fillers. Also warm soaks can help with vasodilation.

Fortunately, it is very very very very rare. I want to emphasize that. Injecting massive amounts of PMMA into the body is not the same as carefully injecting small amounts under a controlled situation. The only exception to the rule is the area between the eyes where the risk is higher. With that area, I only inject when I need to (someone that begs me and would benefit from it). I only use Restylane because I can reverse the product as need be, and the patient has my cell phone for the night in case there is an issue (which is truly rare). Even if they did not have my cell# , my service would get a hold of me. The area (glabella) between the eyes is a higher risk area and should only be injected with precautionary measures and with the right products to manage a situation should it arise.
best,
sml
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery
dr. lam
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Re: Avoiding injecting into blood vessels

Postby dr. lam » Thu Jan 07, 2010 6:51 pm

One more thing. I inject around the eyes with cannulas or in very small areas with a controlled needle (and flashbacks) for safety. When I do fat transfer, it is 100% done with cannulas so when you use a cannula it is virtually impossible to enter a vessel (theoretically but not practically possible). Now, with massive massive doses of an injection of product, theoretically those volumes could compress surrounding vessels but not be an issue for lung emboli. Fat transfer is soft and works very safely so there really should not be any risk like what you are describing.
best,
sml
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery
dr. lam
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Posts: 4999
Joined: Wed Oct 03, 2007 10:51 am
Location: Dallas Texas
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Re: Avoiding injecting into blood vessels

Postby Mysteryagain » Thu Jan 07, 2010 6:57 pm

FANTASTIC answer! You summarized and made more clear to me bits and pieces of info I had learned here and totally answered my questions :). You always are so good at explaining things :).
So happy that you were in Hong Kong and enjoyed your time there so much! Hope you have told more about it somewhere in the forums or the site, I will look for it! :)
Mysteryagain
 
Posts: 254
Joined: Tue Jun 10, 2008 11:19 am
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Re: Avoiding injecting into blood vessels

Postby dr. lam » Thu Jan 07, 2010 7:14 pm

yes, you can check out my flikr photos:
http://www.flickr.com/photos/lamfacialplastics/
and also my video that i shot of my grandfather's university he started:
http://www.lamfacialplastics.com/galler ... u.flv.html
best,
sml
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery
dr. lam
Site Admin
 
Posts: 4999
Joined: Wed Oct 03, 2007 10:51 am
Location: Dallas Texas
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