Aspiration before injection of HA filler. Is it safe?

Question

I'm very scared of having filler injected into an artery. After watching several demonstrations on youtube, I see none of the doctors aspirate before injecting. Why not? I've been told viscosity of the product is an excuse and you should see blood in the syringe if you aspirate in an artery. Also, would a blunt cannula or needle be preferred?

Nima Shemirani, MD · Answer

Hi @AnnaSeattle. Injecting filler into a artery is a very rare occurrence. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Cannulas are safer and reduce the risk of bruising and swelling. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

The risk of injection into an artery is very and small.  Especially lower with someone who is very experienced in injections.  With that said, most fillers can be aspirated using a needle, most easily with Sculptra and least easily with Radieese and Silikon.  With cannulas you cannot aspirate, but the risk of any trauma from cannula is almost none.  I suggest finding an expert in filler injections. Best, Dr. Emer.

Michael A. Zadeh, MD, FACS · Answer

Hi Anna,Your concern is real as injecting filler into an artery can result in serious complications. The risk for this is higher in certain areas of the face. Of course, one of the most important risk factors is the experience of the injector. Extensive knowledge of the anatomy and blood supply of the treated areas is essential in performing filler injections safely. There are techniques which advanced injectors use to minimize the risk of injecting into arteries. I use blunt microcannulas whenever I can and this certainly minimizes bruising, swelling, and other complications so this is definitely an option for you depending on the area you are interested in treated. Please choose your injecting physician carefully. Best of luck.

Stephen Weber MD, FACS · Answer

Aspiration can be attempted but in most cases the needles are so small that you won't see any blood in the hub of the needle. Cannulas are safer and, in theory, should not enter blood vessels. I use cannulas for all of my injectable treatments to try to reduce the risk of arterial emboli. This is uncommon but can have serious complications. Your best bet is to find an experienced physician injector with exceptional knowledge of facial anatomy. Use of cannulas is not a requirement but definitely helps further reduce the risk. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Henri P. Gaboriau, MD, FACS · Answer

Injection of fillers in an artery is a VERY rare occurrence. The main risk would be chocking the artery with too much product around it. If it happens usually strong massage and topical nitroglycerin would be enough to remove the spasm. I do use  blunt needles time to time depending on the location. But the main message is to have your face injected by expert injectors who are well versed in facial anatomy.

Peter J. Jenkin, MD, FAAD · Answer

The risk of intra-arterial injection is a definite concern though it happens extremely rarely.  The risk is higher in certain areas of the face than others.  I do make it a practice to aspirate before each injection-it's easy to do with HA fillers and gives both me and my patient the reassurance that we're being as safe as possible.

Brian Windle, MD (retired) · Answer

This is a good question. 
Injection of fillers into an artery is a definite risk of fillers and
the results can be catastrophic. There are things that can be done to help
mitigate the problem if it occurs but the biggest thing that you can do is to
see an injection specialist who knows the anatomy and uses cannulas where
appropriate.

A cannula is blunt and the product comes out the side.  Therefore the chance of a problem is
minimized and filler injections become much safer.

Repeated injection of an area will also result in scar and
this increases you chances of having a problem. 
For that reason, you might consider long term fillers.  They last at least 5 years and as a result
are much more economical.  I have included a link to the long term filler Artefill.I hope that helps. Best regards.

Aspiration before injection of HA filler. Is it safe?

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