ArTIcLe | beST prAcTIce |
photography is a valuable tool in this process and 3D photography is optimal if available5
. consensus
participants strongly recommended pre-treatment photography under standardised conditions of lighting and positioning. This serves the purpose of documenting pre-treatment appearance, as well as helping stage volume loss and describing it to the patient. It also serves as a baseline for comparison with post-treatment photography used to document treatment effects. It was noted that overhead lighting is very effective in demonstrating the extent of volume loss. patients must be informed of all details of the procedure
and of the potential side-effects. For example, consensus participants apprise their patients of the potential for oedema and discomfort that may occur 24–72 hours post-treatment. based on clinical experience and trial data, the most likely side-effects are transient bruising and swelling, that are mild to moderate in severity. It is most important that patients be educated about the differences between volumising and line filling or dermal filling, so that they are aware of the somewhat greater risk of swelling with volumisers. In addition, although the risk of haematoma is relatively low (e.g. observed in fewer than 3% of patients in the retrospective case analysis4
, patients should be informed that it can occur as a result of the
procedure itself. Some clinicians recommend that patients also receive written information along with pre-treatment instructions. As is standard for any medical treatment, patients should be asked to provide written informed consent before any procedure, including photography, is undertaken and after they have been made aware of all details, including the potential risks and benefits. Although pre-treatment instructions vary across
Figure 4 Restoration of the malar area in a 55-year-old woman. This 55-year-old patient with malar volume loss received 2 mL of Juvéderm™ VOLUMA™ in each malar area of her face with a 21-gauge needle (local anaesthesia with 1.5 mL lidocaine plus adrenaline). Results were evaluated at 3 months, 12 months, and 22 months post-treatment. (A) Before treatment, (B) 3 months post-treatment, (C) 12 months post-treatment, and (D) 22 months post-treatment
clinical practices, it was agreed that patients should discontinue the use of any anticoagulant agents, such as aspirin, antivitamin K therapy, and vitamin e, 1 week before treatment. Also, patients with a history of herpes simplex virus infection (cold sores) should receive prophylactic treatment with antiviral therapy, such as acyclovir. These recommendations are consistent with those for other soft tissue augmentation procedures1, 19–22 A variety of herbal remedies can be used by patients
.
both before and after treatment. For example, some patients and clinicians use topical and/or oral arnica preparations in the belief that it may help reduce swelling and bruising. Additional research is needed to evaluate the benefits of these products and dosing recommendations supplied with the agents should be followed carefully. One regimen is to use arnica granules for 2–3 days before treatment and for approximately 1 week after treatment in combination with a topical formulation. Some consensus participants also advocated the use of antioxidants, but again, this is optional.
The procedure The proposed treatment area should be thoroughly cleaned with antiseptic according to standard surgical practice, because it is a deep tissue injection that comes in contact with fat. Anaesthesia recommendations depended largely on clinician experience and preferences, and include topical and local anaesthetic agents, nerve blocks, and combinations of these. Some of the consensus participants also recommended the use of pre-injection cryotherapy, such as a Zimmer MedizinSystems cooling device. patient preferences should also should be considered. clinicians should not undertake treatment with Juvéderm VOLUMA until they have been trained specifically in the use of this product. As it is a volumising agent, the proper techniques for its use differ substantially from the techniques used for dermal fillers. As with all procedures, a thorough knowledge of facial anatomy is essential for proper use. The fundamentals of the technique are described below, but should not be considered a substitute for specific training. Juvéderm VOLUMA is supplied as one prefilled 2 mL
syringe together with two single-use, 23-gauge, 1 inch needles and two single-use, 18-gauge, 70 mm cannulae17
. 24 ❚
While both needle length and diameter (gauge) can have an effect on the extrusion force required, physicians have some freedom with regard to needle gauge (e.g. 21–23) or cannula gauge (e.g. 18–25) (data from Allergan, Inc.). The selection of needle or cannula for injecting the product is highly dependent on the experience and preference of each treating clinician, and successful outcomes can be obtained with either technique. regardless of technique,
November/December 2011 |
prime-journal.com
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