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Self injecting dermal filler on face

JohnBoy2000

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This is the frightening one to me.

I don't have any immediate plans to do it however, given this is done by so many, it's probably worthwhile documenting risks and potential complications.


The danger seems to come primarily from the potential to "back-fill" a vessel causing either necrosis, or a vessel that innervates the eye - causing blindness.
Although relatively rare in contrast to how many dermal filler procedures performed, it does happen.
There is recommendation to aspirate before injecting the filler, and always do so slowly to minimize rise - but then I've also read current evidence based research doesn't really support aspirating whilst injecting filler - and in contrast to that again, plenty of recent youtube vids of plastic surgeons strongly advocating aspirating before injecting.

That vid outlays primary danger zones - one being the nasolabial folds, a historically popular area to get filler - but more recently being replaced by cheek filler which stretches the creases indirectly.

I'll add more links as I find them but, harm reduction I guess is the point of focus.

Having spoke with a Dr that performs filler procedures, the area she basically ruled out was glabellar region (between the eyebrows).
I've seen vids of plastic surgeons doing filler here using a cannula, but then they're as expert as one can get.

In contrast to botox, which seems to actually be regarded as one of the safest cosmetic procedures available, that outside possibility of complication with filler no matter how small, well in my case at least would force me to preclude every possible risk before I'd even consider it - understanding no-go areas, risk areas etc.
 
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JohnBoy2000

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I’m all for DIY and I’ve done some probably dumb shit but this just sounds like a bad idea. Why not just go to a clinic and get it done...
Roughly 10 to 20 fold difference in the price, depending on the clinic and/or where you by the filler.
 

JohnBoy2000

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Results of good filler, before and after,








There's advocacy now (as demonstrated in above videos) that injecting into the cheek stretches the nasolabial folds thus precluding injecting there as it is a high risk zone.

I gotta say them results look impressive cause heavy/deep nasolabial lines and marionette lines getting treated = huge improvement in appearance, as photos clearly show.

Understanding of 3D anatomy seems an absolute requisite, "knowing where the needle is at all times".

I get some folk advocate respirating and think it precludes all danger but, I can't justify the risk to reward without that level of anatomical knowledge.
 

sekio

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This doesn't sit right with me... you're injecting (hopefully bioinert) filler into your face? The potential for complications must be pretty immense. Even if you inject it correctly it could later diffuse around, or put pressure on nerves/blood vessels too, I would think.

I remember reading about backroom clinics south of the equator that would do similar filler treatments into the buttocks and breasts of women... sometimes using nasty things like brake fluid (it's silicone oil, so must be OK?) or other materials. Some of the results are not pretty at all, nothing like massive tissue necrosis to make one beautiful.
 

Serotonin101

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This doesn't sit right with me... you're injecting (hopefully bioinert) filler into your face? The potential for complications must be pretty immense. Even if you inject it correctly it could later diffuse around, or put pressure on nerves/blood vessels too, I would think.

I remember reading about backroom clinics south of the equator that would do similar filler treatments into the buttocks and breasts of women... sometimes using nasty things like brake fluid (it's silicone oil, so must be OK?) or other materials. Some of the results are not pretty at all, nothing like massive tissue necrosis to make one beautiful.
I mean, necrosis means it rots and falls off so less ugly face left right?
 

JohnBoy2000

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This doesn't sit right with me... you're injecting (hopefully bioinert) filler into your face? The potential for complications must be pretty immense. Even if you inject it correctly it could later diffuse around, or put pressure on nerves/blood vessels too, I would think.

I remember reading about backroom clinics south of the equator that would do similar filler treatments into the buttocks and breasts of women... sometimes using nasty things like brake fluid (it's silicone oil, so must be OK?) or other materials. Some of the results are not pretty at all, nothing like massive tissue necrosis to make one beautiful.
It doesn't sit right with me either.

Injectables are mostly hyaluronic acid typically seems purchased via Alibaba, it's a big seller there, and several outlets on meso seem to stock it also.

There is hyaluronidase, being the enzyme which dissolves it if the injection goes awry - I don't know anything more than that about it, apart from the window to administer this if a blood vessel does become occluded - is very limited.

What doesn't sit right with me is, the potential for things to go wrong if the anatomical knowledge isn't extremely precise.

Even if the possibility was only 1 in 1 million, taking that chance versus the possibility of losing ones eyesight so just a no go for me.

Harm reduction;

I wanted to document information in a discussion thread if for nothing else, than to highlight this issue.

**
The botox is easy.
2500 IU into a blood vessel for systemic effects is necessary.
It comes in 100 IU vials with typically 4 IU per injection site into a muscle belly so, worst case scenario and one does inject into a vain, it essentially doesn't matter.

Filler though, a high pressure glob of filler into a vessel means occlusion.
 

JohnBoy2000

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I like this dudes filler videos cause he seems experienced and has developed approaches outside the box.

Contour and face shape.

What I consider potentially interesting, is muscular activity relative to face shape.

That being, some chicks complain of "turkey neck", which basically means the skin around the lower neck begins to fold and look bad.
This is basically in line it would appear, with cervical flexion - kind of forward head posture.

This can happen when upper chest and anterior neck muscles become tight, whilst posterior neck and cervical spine muscle, become lax.

It can be called, "upper cross syndrome" - though maybe that's just a really excess form of it;



So, most folk wouldn't be that far gone, but we can clearly see how it would cause anterior neck skin to lose that "taught" appearance - "turkey neck".

Simply strengthening cervical muscles - primarily upper traps it seems.

Overhead press or, "the press" - seems to me to be the primary upper body exercise (some folk swear by "shrugs" - I just don't see that same ROM with shrugs and can't logic out according muscular activation - but to each their own).

In my experience, nothing activates musculature like free weights.
Not body weight exercises, not resistance bands - only free weights.
I think it's cause the external unfamiliar load to the body causes the muscles to respond in a way they're not used to, "shocks them", perhaps?
But it activates them like nothing else.

So that alleviates upper cross syndrome - it simply makes all the sense in the world to me it may also implicate skin tonicity and perhaps, maybe - facial folds?
Certainly neck folds;

But additionally via neuromuscular properties like "reciprocal inhibition" (activation of one muscle inducing relaxation in its opposite or antagonist), it may affect facial musculature in some manner.


Teeth grinding and that "moon face" via excess masator growth is one that jumps out at me.
Alleviation of that dramatically implicates facial appearance.

Nasolabial folds and marionette lines?

Who knows?


That good spinal extension is critical for posture so the correct muscles are activated and the skeleton is pulled into the correct position,





This posture shows good spinal extension (not hyper-extension), simply flexing the muscles along the length of the spinal column.
 

GrymReefer

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I've been looking into dermal injections as well and stumbled upon Victorian Cosmetic Institute too! From what I've gathered imo I wouldn't be comfortable attempting self injection of the filler even if you have a very competent level of anatomy. If anything goes wrong it'd just be easier to be in the hand or hands of multiple medical professionals who have applicable experience in the specific procedure. My own dermatologist doesn't do these cosmetic procedures when I asked about additional information, but he did offer me some food for thought in that if I was seeking long-term treatment to essentially mitigate volume loss to investigate fat grafting.
 

sekio

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In my admitttedly limited knowledge of Botox administration in the face, rhe needles used are very, very fine and short, to minimize damage to the delicate structures of the face. It also seems like an awkward location with limited control over needle positioning and insertion angle... it's your own fsce. Even working with a mirror takes a lot of practice. So it's not the sort of thing anyone can do with an insulin syringe.
 

JohnBoy2000

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In my admitttedly limited knowledge of Botox administration in the face, rhe needles used are very, very fine and short, to minimize damage to the delicate structures of the face. It also seems like an awkward location with limited control over needle positioning and insertion angle... it's your own fsce. Even working with a mirror takes a lot of practice. So it's not the sort of thing anyone can do with an insulin syringe.
Botox is easy, I got it my first try. Pinch-technique gets the best results.

Vessel occlusion is the worrying one with filler.


Conclusion
Blindness and stroke have occurred as a result of the injection of soft tissue fillers in almost every part of the face: glabella, forehead creases, temple, crow's feet, nose, cheeks, nasolabial folds, and lower lip. During injection of any soft tissue filler in the face, consideration should be given to the possibility of cannulation of arteries and to the volume of filler injected at any instant. Accidental injection of soft tissue fillers into the arterial system can result in catastrophic complications. The injection of large boluses of soft tissue fillers in the face and the use of needles or cannulas that can easily perforate an arterial wall should be avoided.
Basically says noradrenaline shots into areas for injection to constrict the vessels, and using blunt large bore cannulas reduces risk of occlusion.

Aspirating is common sense to do also.

Avoiding Complications
Sharp cannulas, small cannulas, and needles are much more likely to perforate the wall of an artery and cannu-late the artery lumen than are larger, blunt cannulas. Also, a vasoconstricted artery is harder to cannulate than a vasodilated one. Therefore consideration should be given to the use of larger, blunt cannulas and epinephrine at the injection site for the placement of fillers.

A second consideration is the volume of each injection. For a column of the filler to extend back all the way to the ophthalmic artery or internal carotid artery, a volume of filler must be injected with 1 bolus. When using a larger syringe (20 or 10 mL), the surgeon's control over the volume injected is less than with a smaller syringe. If the surgeon limits the amount of any filler injected to less than 0.1 mL with each pass, the probability of a column of the filler reaching all the way back to the ophthalmic artery is low
Using smaller syringes reduces volume of filler injected to 0.1 ml per pass - vastly reduces probability of occluding an artery.
 
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JohnBoy2000

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When vascular occlusion is suspected, it is vital that the injection is stopped immediately and treatment is rapidly instigated. The goal is to promote blood flow to the affected area, which may be achieved by applying a warm compress, massaging or tapping the area, and applying 2% nitroglycerin paste to promote vasodilatation. Attempts should be made to dissolve or eliminate the injected product. In the case of hyaluronic acid-based fillers, hyaluronidase should be injected all over the affected area, “flooding the area with hyaluronidase”
 

JohnBoy2000

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Just continuing to look into this as I've become determined to at least understand ensuring vessel occlusion or "backfilling" and potential necrosis and blindness is avoided.

Info seems to suggest that,

Blunt tip flexible cannulas of 23G and bigger, when used has almost no recorded history of vessel occlusion.

While there have been cases of vascular occlusion with cannulas, to the author’s knowledge, none have been reported with 23g or larger
I'll probably spend the next period of time scrutinizing this statement from every angle, ensuring its accuracy.


Though this blog seems to assert the same.


Occlusion can happen when injected into the artery, but also extra-vessel occlusion via pressure from outside the artery - but some injectors dispute that, who knows?

If extra vessel occlusion happens, flood the area with hyaluronidase.

But yeah, 23G or bigger cannulas - basically if I was ever getting this done, that's the only way to proceed in my mind.

They require a puncture hole to be made with a needle of large bore, so the cannula will fit - and naturally a nerve block should be administered as, it's effectively twice as large as your standard 30 G needle:


Size chart.

I asked this dude in the comments section about aspiration and whether it's worthwhile.

With cannulas - he seems to think not really.




This piece seems to suggest again, almost all negative aspiration tests can be made positive when larger needle/cannula size is used.

And further safety protocol:
  1. Keep the tip of the needle moving; the injector can then avoid depositing large amounts into any one area, including the intravascular space.
  2. Inject slowly. This allows the injector time to observe any reactions that signify intravascular injection, such as blanching of the skin or sudden extreme pain. It allows one to stop injecting and treat accordingly. Also, slow, low-pressure injections decrease the chance of the filler entering a cut vessel in the area of injection.
  3. Minimize boluses. Boluses can occlude a vessel with external pressure.
  4. Consider using cannulas. We increasingly use cannulas to inject fillers. Because they are blunt tipped, the risk of intravascular injections is theoretically decreased since the cannula does not enter the lumen of a blood vessel.
 
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JohnBoy2000

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The other consideration as to the unreliability of aspiration with fillers - seems to be that some filler actually inhibit aspiration,


In other words, you could be right inside a vessel with the needle, but the filler is so thick that it simply won't allow you to draw blood back, giving a false sense of correct placement.

Take away is, it's typically unreliable.

**


Reports of necrosis using a 27 G cannula.



Blindness with cannula use.
 
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