Utility of Preinjection Aspiration for Hyaluronic Fillers: A Novel In Vivo Human Evaluation. Issue 4 (July 2020)

• Record Type: Journal Article
• Authors: Wang, Jordan V.; Hazan, Ezra; Hattier, Georgette; Torbeck, Richard L.; Khorasani, Hooman; Saedi, Nazanin
• Is Part Of: Journal of cutaneous medicine and surgery. Volume 24:Issue 4(2020)
• Page Start: 367
• Page End: 371
• Publication Date: 2020-07
• Subjects: filler -- facial rejuvenation -- hyaluronic acid -- dermatology -- patient safety; Dermatology -- Periodicals; Skin -- Diseases -- Treatment -- Periodicals; Skin -- Surgery -- Periodicals; Dermatology -- Canada -- Periodicals; Skin -- Diseases -- Treatment -- Canada -- Periodicals; Skin -- Surgery -- Canada -- Periodicals; 616.5005
• DOI: 10.1177/1203475420921387
• Languages: English
• ISSNs: 1203-4754

Abstract

Background: Hyaluronic acid (HA) fillers have increased in popularity. While complications are rare, practitioners should focus on their prevention. Preinjection aspiration remains controversial as an effective safety checkpoint. Objectives: Our study investigated the utility of preinjection aspiration as a safety checkpoint for HA fillers through comparison of physiochemical and rheological properties in a novel in vivo human model. Methods: An in vivo human model consisted of a cannula inserted into a peripheral vein. Preinjection aspiration was evaluated using syringes of 10 commonly used HA fillers. The time required to visualize a flash was recorded. Results: Using a multivariable regression model, needle gauge, HA concentration, elastic modulus ( G ′), viscous modulus ( G″ ), and complex modulus ( G *) had significant relationships with time to flash, whereas pullback volume did not. However, when comparing pullback volume using a more appropriate paired analysis, 0.5 cc pullback volume had a significantly decreased time to flash than 0.2 cc. Conclusions: Preinjection aspiration for HA fillers has utility as a safety checkpoint. The times to visualize flashback decreased when using a human peripheral vein model compared to a previous in vitro model, suggesting that there may be real-time clinical utility of preinjection aspiration. Waiting times to visualize flashback may be affected by physiochemical and rheological properties. Additional studies would help to validate our results.