This content is an introductory course on dermal fillers, focusing on hyaluronic acid (HA) based fillers, their properties, various product lines, injection techniques, and crucial safety considerations for practitioners.
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welcome to the beginner dermal filler
course this is Dr J park with cosmetic
medical training this is a shortened
version of our paid online course the
paid online course is much more detailed
and goes over the following the history
of dermal fillers the differences of
honic acid dermal fillers warnings
precautions consultation steps injection
techniques we'll go over how to inject
areas such as nasol laal folds oral
commer mental lip augmentation perioral
started hyaluronic acid as a principal
polysaccharide in The extracellular
Matrix honic acid is instrumental in
maintaining skin elasticity and fullness
age Associated ha loss results in skin
lack aity and volume deficit cross
length ha forms the basis of most
contemporary dermal fillers which are
predominantly produced by gr positive
bacteria this Innovative development has
led to the creation of non-animal sour hyaluronic
hyaluronic
acid cross-link ha is characterized by
its remarkable
versatility facilitating the
customization of its physical properties
such as hardening
lift duration of survival and resistance
to heat and degrading enzymes it is a
stable cost effective safe tissue compatible
compatible
biomaterial furthermore ha's tissue
residency is significantly prolonged due
to its
cross-linking G Prime is a measure of
the viscosity and elasticity of a dermal
filler it is a dimensionless quantity
that is calculated using the following
formula G Prime equals sheer stress
divided by sheer rate sheer stress is a
force that is applied to the filler to
make it flow sheer rate is the rate at
which the filler flows a higher G Prime
value indicates a more viscous and
elastic filler this means that the
filler will be more difficult to inject
and will more likely to hold the shape
once it is
injected G Prime is an important factor
to consider when choosing a dermal filler
filler
the G Prime value will affect the way
the filler flows and how it holds its
shape for example a filler with high G
Prime would be most suitable for
volumizing and lifting while a filler
with low G Prime value would be more
suitable for filling fine lines and
wrinkles the G Prime value for dermal
fillers vary depending on the type of
filler and the brand in general
hyaluronic acid based thermal filler
have a lower G Prime than calcium
hydroxy appetite based dermal
fillers the G Prime value of a dermal
filler can affect the results of
injections in a number of ways for
example a filler with ti G Prime value
will be more difficult to inject and may
cause more pain conversely a filler with
low G Prime value will be easier to
inject and may cause less pain a filler
with high G Prime value will be more
like lik ly to hold its shape which can
lead to longer results conversely a
filler with low G Prime value will be
less likely to hold shape which can lead
results wrestlin is a comprehensive line
of hyaluronic acid based terop fillers
developed by galderma each with this
unique properties to address different cosmetic
cosmetic
concerns understanding these differences
allows you to choose the most
appropriate product for each patient's
unique needs below is a comparative
exploration of wrestlin products rlin
rlin L silk lift refine Define kiss
contour and
highight wrestling is a flagship product
with 20 milligrams per ml ha and a
moderate G Prime it's versatile suitable
for moderate to severe wrinkles facial
contact touring and lip enhancement the
moderate particle size provides both
lifting and smoothing
properties rlin L is similar to the
original rlin but includes the 3%
lidocaine a local anesthetic for
improved patient Comfort during the
injection the inclusion of Lidocaine
doesn't alter the ha concentration or
the G
prom wrestling still contains smaller
smoother particles around 500 microns
than it's count counterparts making it
perfect for subtle lip augmentation
smoothing Fine Lines especially around
the mouth it has a 20 milligrams per ml
ha but a lower G Prime due to its smoother
smoother
consistency resin lift formerly known as
perlan has larger gel particles and a
higher G Prime offering more substantial
volumizing and lifting capacity it's
excellent for enhancing cheeks and correcting
correcting
volume loss in the midphase ha
concentration is 20 milligrams per
ml wrestlin refine uses expression
technology refine has a flexible gel
consistency providing subtle correction
of laugh lines while maintaining natural
expression it has 20 milligrams per mlha
but the G Prime varies due to the Cross
thinkinking process enhancing
flexibility wrestlin d Define also uses
the expression technology Define has
more cross-linking than refine offering
more support for deeper laugh lines
while still allowing natural facial
movement it also contains 20 milligrams
per ml
ha resellin kiss is tailored for lip
augmentation and smoothing of upper
perioral lines kiss also uses the
expression technology for flexibility
and naturalness it has 20 milligrams per
mL of ha but it unique cross thinkinking
gives it a different G Prime ensuring
longevity and a softer feel Contour is
designed specifically for the cheek and
Chin augmentation it uses the novel
cross thinkinking method of the
expression technology creating a product
with variable G Prime allowing for
excellent lift and Longevity it also has
20 Mig per mL of
ha resellin iight is a specific filler
design for tear trough with a lower ha
concentration of 15 mg per ML and lower
G Prime its softer gel consistency is
ideal for delicate areas like under the
eyes it also contains lioc for added
Comfort during the
injection each resin product is tailored
for different needs with variations in
ha concentrations G Prime particle size
and the presence of lioc cane some newer
products leverage the expression techn
techology for different cross-linking
levels affecting their consistency and
allowing for more natural look while
maintaining volume and lift knowledge of
these will enable you to optimize the treatment
outcomes the juven ranger dermal fillers
developed by Allergan is a well regarded
for its specialized product each
addressing different aesthetic needs a
deep understanding of their individual
characteristics enables you to select
the best suited filler for the patient
the discussion below explores juvaderm
Ultra Ultra XC Ultra Plus XC voluma
Bella bour volux and skin
viiv juviderm Ultra with 24 milligrams
per mL of ha Ultra provides versatility
in treating moderate to severe wrinkles
and folds particularly the nasol laal
fold its moderate G Prime and high
Lacross technology which provides High
degree of cross linking offers a balance
between volume and
spreadability juven Ultra XC like Ultra
Ultra XC offers 24 milligrams per mL of
ha the same degree of cross-linking the
difference lies in the inclusion of the
3% lidocaine intended to increase
patient Comfort during and after
injection duven Ultra Plus XC has a
higher G Prime than Ultra and Ultra XC
do due to more robust cross thinkinking
process resulting a more substantial
lift and higher viscosity it's ideal for
addressing more severe wrinkles and
folds juven voluma is tailored for the
Deep injection into the cheeks to
correct age related volume loss it has a
high G Prime due to proprietary vross
technology which involves cross
thinkinking low and high molecular
weight ha and offers 20 milligrams per
mL of
ha juven Vella is designed for lip
augmentation and correction of the par
oral lines it uses the vross technology
and has a low concentration 15 mgrs per
ML and a lower gep Prime for smooth
consistency suitable for delicate
areas juvenon vour uses a bcross
technology and offers an ha
concentration of 17.5 milligrams per ml
the moderate G Prime makes it an
excellent option for moderate to severe
facial wrinkles and
folds juven volu designed for the lower
face volu is used to sculpt chin and
jawline it uses the vross technology and
has a high G Prime and an ha
concentration of 25 milligrams per ml
ensuring longevity and a significant
lift juviderm skin VI is designed for
superficial dermal injections to improve
skin quality texture and icity its ha
concentration is lower in summary
difference among the juven filler range
from variation in ha concentration G
Prime inclusion of Liane through the use
of proprietary technology like hros and
viacross the specific characteristic of
each product is designed to optimize
outcome for different cosmetic needs and
a detail understanding of these is
patients developed by to oxin
Laboratories resilient honic acid or
RHA fillers are the first thermal
fillers designed for dynamic areas of
the face adapting and stretching to work
with facial movements the family
consists of RHA
redensity rha2 rha3 and four the
specific details and key differences are explored
explored
below RHA reden it has a concentration
of 15 mg per ml its low G Prime makes it
ideal for injection into the dermis and
superficial dermis of the face for the
correction of moderate to severe dynamic
perioral rids in adults age 22 years or older
older
rha2 has an ha concentration of 23
milligram per ML and is intended to fill
moderate facial wrinkles it has a
moderate G Prime allowing it to balance
between firmness and
flexibility the ha and rha2 is
cross-link which increases its viscosity and
and
Longevity rha3 also has an ha
concentration of 23 milligrams per ml
but has a higher G Prime than rha2
making it firmer and more suitable for
filling severe facial wrinkles and fold
such as nasal labial folds
folds
rh4 also has 23 milligrams per ML and
has the highest G Prime in the RHA
series and is tailored for correction of
severe wrinkles and facial
Contours typically used for volumizing
jawlines a key feature of the RHA series
is its preserved Network technology
unlike other fillers that can lose their
structural Integrity upon injection the
RH series preserves a native ha
structure resulting in a more natural
look and
feel the vers a line of hyaluronic acid
based thermal fillers are each known for
their unique manufacturing processes and
properties Versa manufactured by prenium
is a homogeneous monophasic dermal
filler that contains 24 milligrams per
mL of ha the product is created using a
proprietary wet Milling technology which
produces spherical and uniform particles
these particles result in high quality
ha reducing inflammation and
Longevity Versa has a relatively high G
Prime giving it a good lifting
capacity Versa plus is also part of the
same perenium portfolio it's similar to
the original Versa but includes lioc
cane for enhanced patient Comfort during the
the
procedure lips plus is specifically
designed design for lip augmentation
lips plus is another penum product with
24 mg per mL of
ha here we'll explore the specific
details and key differences between
belloto balance and bellal balance
plus bellotero balance is manufactured
by Ms Aesthetics bellot teral balance is
unique due to its cohesive poly
densified Matrix technology
which produces a smooth flexible gel
Bello balance has a 22.5 mg per ml ha
and a moderate G Prime that offers
balance between lift and spread this
filler is suitable for moderate lines and
and
wrinkles bellaro balance plus is similar
to bellaro balance but contains 3%
injection combined list of
contraindications dermal fillers are
contraindicated for patients with severe
allergies manifested by a history of
anaphylaxis or history or presence of
multiple severe
allergies dermal fillers which contain
Trace Amounts of gr positive bacterial
proteins are contraindicated for
patients with a history of allergy to such
such
material dermal filler should not be
used in patients with previous hypers
sensitivity to local anesthetics of the
Ami type such as
Lane dermal fillers should not be used
in patients with bleeding disorders
dermal fillers are contraindicated for
use by anyone with skin infection or a
susceptibility to choid formation or
hypertrophic scarring dermal fillers
should not be used by pregnant women or nursing
nursing
mothers patients under the age of 22
should not be treated with certain types
of dermal fillers patients with evidence
of scars at the intended treatment cite
should not be treated with dermal
fillers patients with acne or other
inflammatory disease of the skin should
not be treated with dermal fillers
patients with unattainable expectations
should not be treated with dermal
fillers dermal fillers should not be
used in patients who have plans to go
undergo desensitization
therapy dermal fillers should not be
used in patients with acute or chronic
skin disease in or near the injection
sites or with any infection or un healed
wounds of the face patients under
anti-coagulant therapy antiplatelet
therapy or with a history of coagulation
defects or connective tissue disorder
should not use dermal fillers dermal
fillers are not intended for
intravascular use and must not be
injected into blood vessels as
implantation into dermal vessels may
cause vascular inclusion infarction or embolic
embolic
phenomenon dermal filler should not be
used in conjunction with laser IPL
chemical peeling Derm bration treatment
or with over-the-counter wrinkle
products or prescription wrinkle
treatments within four weeks prior to
treatment please note that this list is
a combination of all Contra indications
from each products and each individual
products may not have every listed
contraindication always refer to the
specific products package insert this is
a combined list of all the specific warnings
warnings
avoid injecting dermal fillers directly
into blood vessels as this may cause a
vessel occlusion embolization or
infarction rare but serious Adverse
Events associated with the intravascular
injections of soft tissue fillers in the
face have been reported to include
temporary and permanent Vision
impairment blindness cerebral esea or
cerebral hemorrhage leading to stroke
skin necrosis and damage to underlying
facial structures use of these products
on patients who are pregnant
breastfeeding or under age 18 years old
have not been studied and therefore not
recommended the safety and effectiveness
of these products for the treatment of
areas other than those specified in the
respective FDA approved labeling has not
been established do not over correct or
overfill a contour deficiency because
the depression should gradually improve
as the treatment continues do not mix
these products with any other products before
before
implantation as with all skin injection
procedures there is a risk of infection
injections greater than 1.5 ml per lip
upper or lower per treatment session
significantly increases the occurrence
of a severity of lip
swelling Dillers should not be used in
areas that have high vascularity as
there is a risk of vascular
embolization injection site reaction
such as redness temporary swelling
tenderness and pain have been observed
in our short-term in duration less than
7 Days any reaction in excess of this
anticipated reaction should be reported
to their health care
professional this product should only be
used by Healthcare practitioners who
have appropriate training experience and
knowledgeable about the anatomy at and
around the S of
injection patients with adverse
inflammatory reactions that pers persist
more than one week should report this
immediately to their physician healthc
care practitioners are encouraged to
discuss all potential risk of soft
tissue injection with the patient prior
to treatment ensure that the patient are
aware of signs and symptoms of potential
complications serious Adverse Events
have been reported relate to the use of
dermal fillers in the areas of the eye
localized superficial necrosis scarring
may occur after injection in or near
vessel such as the lip nose and Gellar
area it is thought to result from injury
obstruction or compromise of blood
vessels the laate on set inflammatory
papules have been reported following the
use of dermal fillers inflammatory
papules that may occur rarely should be
considered and treated as a soft tissue
infection These Warnings provide
important information for safe and
effective use of dermal fillers and
should be carefully considered by Health
Care Providers and patients alike it is
essential to reach out to respective
product manufacturers or healthc care
providers for additional
information pre precaution dermal
fillers are intended for single use only
they should not be sterilized or used if
the package is open damage or past its
expiration date the product should be
used with caution in patients undergoing
immunosuppressive therapy or patients
who are using substances that reduce
coagulation the injection of dermal
fillers into patients with history of
herpetic eruptions may lead to
reactivation of the
herpes the patient should be informed
that they they should minimize exposure
of the treated area to excessive sun or
heat UV lamp exposure saunas and extreme
cold weather until any initial swelling
and redness has resolved and puncture
site have
healed any syringe that shows signs of
content separation or appears cloudy
should not be used if nodule or
persistent papules occur consider
appropriate treatments such as high idas
injection or surgical
removal prior to treatment patients
should avoid taking aspirin Neds St
John's wart or high does vitamin E
supplements as these agents may increase
bruising and bleeding at the injection
site injection thermal filler injections
require a meticulous technique to
achieve optimal results and minimize
complications always insert the needle
into the mid to Deep dermis for
appropriate product placement you can
gently stretch the skin to Aid the
needle insertion which can also help
visualize the treatment area better the
Contour of the needle should be barely
visible or not at all depending on the
type of filler use and the severity of
the wrinkle being treated if utilizing a
Threading technique apply even pressure
on the syringe plunger while slowly
retracting the needle ensure you stop
the injection before completely removing
the needle to prevent the products from
booing out superficial injection can
cause a bluish Hue on the skin due to
the Tindle effect if this occurs
consider massaging the product deeper
into the tissue expressing it out or
dissolving with higher
onidas in the Fanning technique keep the
needle inside the skin while angling the
syringe and reasserting the needle to
the hub be aware of potential for
intravascular injection if blanching
occurs immediately stop injecting
massage area until normal skin color
returns throughout the procedure you
should always feel the resistance of the
dermis indicating the correct plane of
injection if you encounter too much or
too Little Resistance you may be in the
wrong plane at the end of the treatment
the injected wrinkle should be visibly
lifted and
filled the level resistance that you may
feel depending on the area that you are
injecting injection in the periole space
may have very Little Resistance versus
injecting into the Derma
space post injection after administering
the dermal filler a careful evaluation
is critical to ensure an optimal result
the treated area should feel smooth with
no detectable empty spaces or lumps
strive for a precise correction neither
under nor over corrected gently massage
the injection site to blend the product
with the surrounding tissue if you feel
feel any bumps or lumps massage them
until they flatten in most cases any
protrusions will resolve naturally but
reassure the patient and schedule a
follow-up appointment within a week if a
lump persists at this followup consider
using higher onidas to dissolve the
filler symmetry assessment immediately
post injections can be challenging due
to localized swelling and bruising
invite the patient back after a week for
re-evaluation once the swelling has
subsided lastly any post injection
swelling or internal bruising should
resolve in a few days to minimize these
side effects provide your patient with
an ice pack which can also help to
reduce potential
bleeding injection technique the success
of dermal fillers is not only dependent
on the type of product used but also on
the injection technique there are
various injection techniques each with
its own set of advantages and potential
pitfalls serial puncture the serial
puncture technique involves multiple
closely spaced injections along a
wrinkle the key to this technique is the
precise placement of the filler if the
filler is not accurately placed gaps may
be found between the injection sites
this technique is less desirable due to
multiple puncture wounds it generates
however it can be effective for treating
fine lines and wrinkles provided that
the practitioner has a steady hand and a
keen eye for
detail linear threading linear threading
is a technique where the needle is fully
inserted into the wrinkle up to the hub
and the product is injected along the
tract as the needle is gradually
withdrawn this technique requires
continual pressure and even distribution
of the product this requires a certain
level of skill and dexterity as
practitioners must simultaneously push
the plunger of the syringe while pulling
back the syringe from the
skin it is crucial to stop the injection
several millimeters before completely
removing the needle from the skin to
avoid superficial placement or leakage
of the product above the
skin some practitioners prefer the push
ahead technique where the product is
injected as the needle is being Advanced
through the skin with practice this
technique can be mastered and can
provide a smooth even distribution of the
the filler
filler
cross-hatching cross-hatching is a
technique that involves injecting a
series of par parallel linear threads at
5 to 10 mm apart followed by a
perpendicular series of parallel linear
threads at the same distance this
creates a grid-like pattern and is
particularly useful for adding volume to
a larger area or when multiple wrinkles
are close in proximity the
cross-hatching technique allows for a
more uniform distribution of the filler
resulting in a more natural looking
result Fanning the Fanning technique
involves puncturing the epidermis once
as in the linear threading technique and
before the needle is completely removed
from the skin the needle is moved in a
fanlike pattern to create a triangular
shape additional evenly spaced Fanning
injections may be performed without
removing the needle from the skin
depending on the sides of the Triangular
area to be filled care must be taken to
avoid over injecting at the proximal end
of each fan as this can result in an
overlap a product in one region
region
ferning ferning or fencing is a
technique that involves short linear
threading perpendicular to the fold
followed by advancing a few millimeters
away from the fold in either direction
this technique is typically used on
Dynamic facial lines that require
stiffness of the skin on either side of
the wrinkle the ferning technique can
provide a more structured support to the
skin helping to smooth without Dynamic
lines and
wrinkles nasal labial
folds the nasal laal fold is a
noticeable line or crease that extends
from the lateral borders of the nostril
to the corner of the mouth a signifier
of facial aging the formation of the
nasal laal fold occurs due to several
anatomical changes with age such as the
gradual medial and inferior movement of
the maer fat pad caused by collagen loss
and diminish skin elasticity a heavy mid
face as seen with aging or obesity might
amplify the depth of these
lines for the provider it's essential to
understand the intricate anatomy of the
nasal labial fold area it consists of
five layers skin subcutaneous fat
superficial muscular aponeurotic system
facial muscles and the per oium of the
Magilla the vascular structure around
this area include the facial artery
angular artery and infraorbital artery
as the facial artery runs near the nasal
labial fold always aspirate before
injecting to avoid intravascular
injection and subsequent complications
when treating nasolabial folds the
choice of dermal filler is critical
older patients with deeper folds might
need a higher G Prime filler G Prime
refers to the elasticity or firmness of
a filler higher G Prime fillers can
create lift and sustain their form under
pressure which is beneficial in the
areas where a more substantial
correction is required injection
technique varies depending on the folds
depth for shallow and medium folds
linear threading with Fanning is
typically used this involves a
retrograde injection technique where in
the needle is inserted at the lower part
of the nasal labial fold and Advance
superiorly towards the nose depositing
05 to .1 mL of the filler per injection
Fanning a technique where injections are
administered in a starburst or radial
pattern it's particularly useful at the
upper y-shaped area beneath the Nars and
the lateral area to the
Alla however when progressing fly
towards the oral commissure the
correction duration tends to decrease
due to increased muscular activity also
the correction here may be challenging
due to the lack of underlying bone and
the gravitational effect on the cheek
tissue following the injection the
provider should mold the filler to
ensure optimal distribution and
smoothness this is accomplished by
placing a glove thumb on top of the
treated fold and one or two fingers
inside the mouth then gently molding
along the injection site to check for
nodules or lumps ha fillers are
particularly amenable to molding due to their
their
malleability however while while
treating the nasol labial folds multiple
superficial lines lateral to the folds
might tempt an injector these lines are
often a result of dynamic facial
expression and should be addressed
cautiously as treating these might lead
to a visible filler implantation during
facial movement which may appear like
cordlike structures on the
face post-procedural monitoring is
crucial and patients should be educated
about potential complications such as
swelling redness pain bruising lump skin
necrosis and even rarer complications
like blindness due to Accidental
intraarterial injection additionally
patients should avoid vigorous physical
activities exposure to intense heat or
cold and alcohol for the first 24 hours
postprocedure to minimize risk and
enhance recovery remember while
hyaluronic acid fillers provide an
effective minimally invasive approach to
correcting the nasal laal fold patient
safety and aesthetic results should
always be the primary concern therefore
a thorough understanding of the facial
Anatomy injection techniques and product
characteristics are prerequisites to
performing these procedures safely and
effectively lip augmentation the art of
balance and precision the lips reaching
their Peak volume by the mid-30s
represent a Hallmark of beauty and
usefulness however with age features
such as the Vermilion border fital Ridge
and Cupid's bow undergo changes
including thinning drooping and
flattening the upper lip often becomes
thin and elongated whereas the lower lip
Thins and rolls inwards simultaneously
the orbicularis orus muscle activity
contributes to radiating perioral lines
commonly referred to as lipstick lines
achieving a Natural Balance augmentation
of the lip is a complex task requiring a
thorough understanding of facial
proportions anatomy and the unique
characteristics of dermal fillers when
discussing proportions it's generally
accepted that the lower lip should be
Fuller than the upper lip with an ideal
ratio of 1 to 1.5 according to the foni
sequence the clinician's approach must
be nuanced according to the patient's
age younger individuals seek to enhance
the size and shape while even small
volumes of filler 0.1 to3 ml can
significantly enhance the lips
appearance caution should be exercised
to prevent the undesirable duck lip
appearance older patients in contrast
generally wish to restore the lips to
their previous state rather than
increasing size such patients may not
desire a lip diversion or an unnatural
appearance and might require adjunctive
treatments like laser resurfacing or
chemical peels for perioral wrinkling or
deep lipstick bleeding P pain during the
procedure can be managed by using ha
products containing leaine nerve block
or topical
anesthetics however if nerve blocks are
used it's crucial to work promptly as a
numbing can distort the lip
position in terms of injection
techniques threading is recommended for
minimizing puncture sites the Vermilion
border and the wet dry Junction are
common targets for lip volume
enhancement to increase lip size and
provide lifts and cont tour the needle
should be inserted 1 to 2 mm from the
Vermilion border towards the mucosal
border creating a ski jump appearance
however overfilling near the Vermilion
border should be avoided to prevent the duck-like
duck-like
appearance when focusing on volume
enhancement the needle should be
inserted 3 to 5 mm from the Vermilion
border near the wet dry border which
will plump up the lips without inverting
the edges for enhancing the filal column
the needle should be inserted at the
junction of the Cupid's bow and the
fital column advancing
superiorly vertical lip line can be
managed by direct injection of the lines
or along the Vermilion border care
should be taken to use minimal amounts
to prevent overcorrection and unnatural
bulging as lips are a focal point of the
face Precision is Paramount over
correction or asymmetry can be glaringly
apparent in addition lips Rich
vascularity make them prone to
complications such as bruising and
swelling it's recommended to apply ice
post procedure to mitigate these
immediate side effects and to ensure
equal amounts of fillers are
administered additionally due to their
high G Prime fillers such as juviderm
voluma or resellin lifts are generally
avoided in lips favoring softer fillers
such as juviderm Vella or reslin silk to
avoid lumpiness and provide a smoother
softer feel
potential complication include not only
the immediate post treatment swelling
and bruising but also longer term
problems such as lumps bumps asymmetry
and more seriously vascular cusion in
the case of vascular clusion immediate
management with honas is
critical in conclusion ha dermophil
injection and the lips require a deep
understanding of the lip Anatomy precise
injection techniques and careful patient
selection and counseling a conservative
approach with a focus on balance
proportion can yield the most satisfying
and natural
results high Al urones is an enzyme that
hydrolyzes and breaks down hyaluronic
acid facilitating the successful
elimination of unwanted ha
implantation it's been utilized
effectively to correct a symmetry
overcorrection tndo effect and Vascular
occlusion honas dissolves the filler and
reduces edema thereby helping to
minimize uded vessel pressure for use
higher Rodas is eluded with saline in a
1:1 ratio mandatory skin testing
involves injecting 3 to five units
intradermally a wheel formation within 5
minutes persisting for 20 to 30 minutes
with localized itching indicates a
positive skin test a total of 10 to 30
units should be injected per 2x 2 cm
area of impending necrosis it's crucial
to check the package insert for for any
honas product for complete instructions
and information regarding warnings and
contraindications attempts should be
made to dissolve or eliminate the
injected product in the case of
hyaluronic acidbase fillers Huron should
be injected all over the affected area
flooding the area with honas as soon as
possible and a dose applicable to the
product to be reversed for example 10 to
20 units per injection point
honas injection should be repeated on a
daily basis where appropriate and
continued for at least four days as long
as there are signs of esea an
anti-coagulant such as low molecular
rate Hein aspirin or Plavix could also
be prescribed to increase blood flow to
the wound other authors have suggested
the use of Viagra to dilate the compromised
vasculature this is Dr J park with
cosmetic medical training thank you for
watching or listening if you have any
questions please contact us at email
cosmetic medtraining
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