For plastic surgeons, learning 'danger zones' can increase safety when using facial fillers

Dermal fillers have become a popular alternative to surgery for patients who want a younger facial appearance. Learning about some key "danger zones" can help plastic surgeons to enhance the safety and effectiveness of facial filler procedures, according to an expert update in the May issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The article is written by Rod J. Rohrich, MD, and colleagues from the Dallas Plastic Surgery Institute. Rohrich also serves as editor-in-chief of Plastic and Reconstructive Surgery. The article is accompanied by a set of online videos illustrating anatomically-based techniques to minimize risk and maximize safety when using dermal fillers in specific areas of the face.

"Given current trends, it becomes even more important that plastic surgeons, dermatologists, oculoplastic surgeons and facial plastic surgeons learn safe, predictable techniques to achieve optimal results with facial filler injections," said Dr. Rohrich.

Videos Illustrate 'Danger Zones' in Facial Filler Injection

Injection of soft tissue dermal fillers can reduce facial lines and wrinkles and restore a fuller, younger-looking facial appearance. Providing immediate results with a short recovery time, dermal filler injection has become the second-most popular nonsurgical cosmetic procedure (behind botulinum toxin injection). According to ASPS statistics, more than 2.6 million dermal filler procedures were performed in 2016.

When performed by a board certified or experienced practitioner facial filler injection is a safe procedure. Complications are uncommon and generally mild. However, rare but serious complications have been reported, occurring especially with inadvertent injection blood vessel damage or injection of the filler material into the blood vessels.

Dr. Rohrich outlines his approach to specific principles for safe filler injection, including the use of hyaluronic acid fillers when possible. The major advantage of these products is that their effects can be rapidly reversed by rescue injection with the enzyme hyaluronidase. Of the 2.6 million dermal filler procedures performed last year, 2 million were completed using hyaluronic acid fillers. Other principles for safe filler injection include the use of continuous motion and gentle injection techniques.

"Most importantly, practitioners should be able to recognize complications and address them immediately," Dr. Rohrich said. "They should pay particular attention to the six danger zones from the forehead to the chin, areas commonly addressed by facial filler injection."

In the online videos, Dr. Rohrich demonstrates and narrates his approach to dermal filler injection in each area. He explains the steps to protect the underlying blood vessels, while discussing the filler products and injection techniques to achieving the best results in each area. The videos also include cadaver dissections demonstrating the course of the underlying blood vessels in each danger zone, as well as before-and-after views showing the facial rejuvenation results.