Aspiration in aesthetics is thought to be an absolute necessity by many practitioners for safety reasons.
However, it is controversial, especially for those who do not know much about it. Dr Adam, one of the aesthetic clinicians in our leading clinic, SkinViva, points out 5 things you need to know about aspirating:
What is aspiration?
This is only relevant for dermal fillers rather than Botox and refers to fixing our needle in the position we are about to inject, pulling back on the plunger of the syringe and ensuring no blood has pulled back into the syringe. If there is blood, this would imply that we might be in a blood vessel and hence not safe to inject.
Why is it considered by some to be important?
Intra-arterial injection of filler can block the flow of blood, potentially leading to skin necrosis, ulceration and scarring. Embolisation of filler can even enter the central retinal artery and cause blindness. Anything we can do to minimise this risk could be argued worthwhile!
What might be some of the drawbacks with aspirating?
There may be a false sense of security if the aspiration is negative and then a potential ‘gung-ho’ approach to pushing filler in that very spot – but there are some issues with the accuracy of aspiration. Firstly, even a tiny amount of movement could potentially move your needle out of a safe zone into an artery in the time from completing aspiration to then injecting. Secondly, many argue that the small diameter of the needles means it is very difficult to actually draw up blood, and the force and pressure required may collapse the blood vessel your needle tip might be in …hence a false negative result.
Other issues such as the speed you pull back on the syringe, the viscosity of the filler and whether or not the syringe is properly primed are some of the other issues often argued as reasons that aspirating may not be as reassuring as we think.
So, do the experienced clinicians in the industry all aspirate?
There was an interesting article on the Consulting Rooms website recently which interviewed several clinicians from different areas of the country and different clinics. Opinions were divided. A small survey they carried out showed that only 65% of injectors were aspirating all of the time.
I’m still not sure from reading all of this – what should I do?
Ultimately, that is up to you as a clinician, but here at SkinViva, we see safety as an absolute priority, and considering we have all had positive aspirates at some point (I recently had one doing a non-surgical rhinoplasty!), and a very low complication rate, along with good knowledge of anatomy, I think aspiration fits well with our day to day clinical practice in trying to mitigate any risk from fillers. At the end of the day it is also extremely important to be be able to counsel your clients properly, and also have the knowledge and tools to deal with a complication (i.e. Hyalase -see our YouTube videos for a explanation of how to draw up and administer hyalase).
Other things you can do to lower your risk of complications include injecting slowly, under lower pressure, using small amounts at a time (remember arteries can be compressed if a dense fillers is used in an area where the artery doesn’t have much room e.g. the tip of nose) and the use of a micro-cannula which is blunt tipped and can reduce the risk of piercing a blood vessel.
Your Questions About Aspirating
If you have any questions around aspirating that you’d like answering, please comment below.
What others say about this post? (11 Comments)
No you don’t 🙂
I have a problem where when aspiration they whole plunger comes out? What is causing this to happen?
Hi Tara, I’m not too sure, to be honest? where have you got the filler from? SVT Team
I understand the concept of aspiration when using needle. What about cannula, do we need to aspirate while using cannula? On every movement?
Hi Dilber. The short answer is yes, particularly in the nose – very important there.
Do you have any tips to ensuring stability when aspirating? I aspirate during every injection but often find it difficult to maintain 100% stability and accuracy when doing so.
Hi, people normally steady themselves with their non-injecting hand. You may find this video by Dr Tim Pearce helpful: https://www.facebook.com/doctortimpearce/videos/2224007097614802/. If you are a delegate of SkinViva Training Academy, this would be a perfect question for the Facebook SkinViva Trainee Network https://www.facebook.com/groups/876376669045280/ to get advice and tips from other practitioners too.
Once you have aspirated can you still keep the syringe of filler in the fridge for that same person or does it have to be discarded? I was trained that you can keep filler once opened in the fridge for 2 months and reuse but they never advised me to aspirate but I would rather be safe and do this many thanks
None of the manufacturers of fillers that we are aware would recommend keeping filler once opened, regardless of aspiration. Some studies show that it remains sterile, but others have shown evidence of bacterial growth. We would advise playing it safe and not keeping filler once opened, but we don’t believe there is strict guidance on this. The main concern would be that if client developed am infection they allege that it was due to reuse of the filler.
With a positive aspirate, is the syringe of filler usable or should it be disposed of?
Would the blood not make a second positive aspirate difficult to recognise?
Thank you for your question, Hilary. You expel any blood stained filler by pressing on plunger (over piece of gauze). Then change needle to fresh one. After that can keep treating but slightly alter position to avoid the vessel that was hit – Dr Sharan.