Would diluting hyaluronic acid with saline reduce the chances of occlusion?

Question

I want to receive filler in the safest way possible. Would a saline/HA mix help with safety?

Nirmal Nathan, MD · Answer

Dear zarazi,Based on our current information, dilution with fillers with saline will not reduce the chance of embolization. It may also make the injection less predictable due to the carrying potential of the saline.Best regards,Nirmal R. Nathan, M.D.
  
Certified, American Board of Plastic Surgery
  Member, American Society of Plastic Surgeons
  RealSelf Top Doctor and RealSelf Hall of Fame

Hung William Song, MD · Answer

I often use lidocaine to thin out an HA filler if I am injecting very superficially so that it integrates more smoothly into the tissue. It is safer because superficial injections are less likely to cause fillers going into a blood vessel. However, if the thinned out filler is injected deeper into a vessel, it may actually be more likely to cause an embolism (travel further into the vessel) and cause serious complications like vision loss. I like using micro cannulas when injecting deeper.

Kristen Aliano Messina, MD · Answer

Hi, Thanks for your question.  Diluting filler with saline will not increase the safety.  Using blunt cannulas, slow-injection technique, and having a trained, qualified plastic surgeon to perform the injections can improve safety.

Shaun Patel, MD · Answer

No, diluting the filler with saline will not reduce chances of occlusion in my opinion. Slow, low pressure injections using a 25 gauge or larger microcannula and treatment by an experienced injector will help minimize but not eliminate risk.

Jean M. Casello, MD · Answer

Mixing a hyaluronic dermal filler with saline will not make it safer to inject. This mixture will also result in less efficacy of the product.  There are precautions that an injector can take to ensure that the filler is being injected in a safe and effective manner. It is important to consult with an experienced injector to minimize complications.

Ben Brown, MD (license emergency restriction) · Answer

Good question!
It's very important that you receiver filler safely. What seems like such a benign procedure can rarely lead to devastating complications if not done correctly, and it's great that you recognize the importance. There are a number of precautionary steps to take when injecting hyaluronic acid filler to minimize the chance of complications. Diluting filler has been used in certain areas to aid in the aesthetic outcome of some otherwise difficult-to-treat areas, but it has not been shown to increase the safety of injection.
The Global Aesthetics Consensus Group recently published guidelines to which injectors of filler should adhere to minimize complications, namely intravascular injection of filler. These guidelines included, among other things, a thorough knowledge of the anatomy and danger zones of the face, aspirating before injecting, moving the needle while injecting, and using small quantities with each pass. 
While this is statistically a very safe intervention, the best way for you to maximize your safety is to seek a board-certified plastic surgeon that has had years of training and a strong background in both medicine and anatomy. They will be the most well-equipped to safely administer the filler, and best prepared to address any complications quickly, should they arise. 
Good luck and I hope this helps!

Rita Rakus, MBBS - Account Suspended · Answer

Thanks for your question.You are completely right to be cautious with filler injection as there is a rise in complications due to untrained injectors performing these treatments. Mixing the filler with saline would not make there treatment safer and it would also likely result in you not getting a result either.My advice would be to seek a qualified and experienced practitioner for any cosmetic work you wish to have

Would diluting hyaluronic acid with saline reduce the chances of occlusion?

Answers (7)

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