HA filler remove through cannula aspiration?

Question

What are your thoughts on manual filler removal through ultrasound guided cannula suction / aspiration? There are a small handful of Drs who use this method and very few studies online on this method. I have a consult with a Dr. who does this. I’d like some other opinions. What is the feasibility of this method? Risks?

James M. Economides, MD, FACS · Answer

Manual filler removal using ultrasound-guided cannula suction/aspiration is a relatively new and emerging technique, and while some doctors offer this approach, it is not yet widely adopted. Here are some considerations regarding the feasibility, risks, and general thoughts on this method:

Feasibility:
Precision: One of the key benefits of using ultrasound guidance is the ability to locate the filler precisely in deeper tissue planes. This technique allows the injector to visualize exactly where the filler is and target it more accurately than traditional blind aspiration or dissolving with hyaluronidase.
Aspiration Method: The idea behind using a cannula for suction/aspiration is that it provides a minimally invasive way to physically remove the filler. This can be beneficial if a patient has experienced overfilling or filler migration and prefers mechanical removal rather than dissolving agents like hyaluronidase, which may affect natural tissues or result in uneven dissolving.
Risks:
Invasive Nature: While it's less invasive than surgery, any procedure involving a cannula carries risks, including:

Infection: Inserting a cannula to remove filler carries a small risk of introducing bacteria, which could lead to infection.
Scarring or Tissue Damage: Depending on how deep the filler is and how aggressively it's removed, there may be a risk of scarring or trauma to the underlying tissue, particularly if the cannula causes damage during the aspiration process.
Incomplete Removal: Filler tends to integrate with the surrounding tissues over time, and physical removal might not always be able to extract 100% of the product, especially if the filler has migrated or diffused over a larger area. Some areas may still require additional hyaluronidase treatment to fully remove the filler.

Ultrasound Accuracy: While ultrasound is helpful for visualization, it depends on the skill of the provider. If the practitioner is not highly experienced with ultrasound-guided procedures, there’s a risk of missing some areas of filler or causing tissue injury.

Unknown Long-Term Outcomes: Since this method is still relatively new and not well-documented in the scientific literature, there may be unforeseen long-term risks or complications. The lack of large-scale studies means there isn’t yet comprehensive data on long-term success rates or safety.

Benefits:
Avoiding Hyaluronidase: For individuals who have concerns about using hyaluronidase due to allergic reactions, fear of over-dissolution, or preferring not to use it, manual removal could be a viable alternative.
Controlled Filler Removal: This method may offer better control over how much filler is removed, avoiding the risk of dissolving natural tissue along with the filler, which is a potential issue with hyaluronidase.

Anna Chacon, MD, FAAD · Answer

Thank you for your question. Manual removal of hyaluronic acid (HA) fillers through ultrasound-guided cannula suction/aspiration is a relatively novel technique. Here are some key points to consider:

Feasibility:

Precision: Ultrasound guidance allows for precise localization of the filler, which can enhance the accuracy of the aspiration process. This can be particularly useful in cases where the filler is unevenly distributed or has migrated.

Effectiveness: While there are limited studies on this method, anecdotal evidence and preliminary reports suggest that it can be an effective way to remove unwanted filler. However, the success can vary depending on the type and amount of filler, as well as its location.

Experience: The skill and experience of the physician performing the procedure are critical. As this is a specialized technique, it’s important to ensure that your doctor has substantial experience and training in ultrasound-guided procedures.

Risks:

Incomplete Removal: There is a possibility that not all of the filler will be removed in one session, which may necessitate additional treatments.

Tissue Damage: The procedure involves the insertion of a cannula into the tissue, which carries a risk of bruising, swelling, and potential damage to surrounding structures.

Infection: As with any invasive procedure, there is a risk of infection. Proper aseptic technique and post-procedure care are essential to minimize this risk.

Scarring: Although rare, there is a potential for scarring, especially if multiple attempts are needed to remove the filler.

Pain and Discomfort: Some patients may experience pain or discomfort during and after the procedure.

Conclusion:

While ultrasound-guided cannula aspiration is a promising method for HA filler removal, it is important to weigh the potential benefits against the risks. I recommend discussing these points in detail with your consulting physician, and considering a second opinion if you have any concerns.

Best regards,

Barry Kusman, MD, FACS (retired) · Answer

Hello, this methodology would best be accomplished by a Facial plastic Surgeon. Especially, if the patient has had previous face lift's. This depends on the experience of the injector as potential complications can include blindness, necrosis of tissue, deformation of the face or skin. Make sure the provider is licensed and qualified. I would make sure to get multiple opinions and do your research prior.

HA filler remove through cannula aspiration?

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HA filler remove through cannula aspiration?

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Everything you need to know about Cheek Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.