The author presents a useful overview of some of the contributory factors for impending necrosis. It is important to note that compression may not always be due to excessive placement of product or placement within a vessel; the viscosity and anatomical placement of product are equally important considerations. Emphasis is placed throughout the article on ‘high risk areas’ for injection; yet, anatomically any region where dermal filler is placed has the potential for unwanted and serious side-effects due to the complex vascularisation of the face. The importance of a sound anatomical knowledge must be reinforced, particularly in preventing such a devastating complication; there is little acknowledgement of this. Sound evidence indicates that compression to a vessel may present some time following treatment, and not always immediately post procedure, as the author suggests. The article does allude to the concern of suspected under-reporting of non-surgical complications and the challenge in identifying accurate and consistent statistical data in terms of these figures. The importance of a thorough medical consultation is addressed, yet previous treatment with dermal fillers is not discussed, which may have been an interesting point in terms of proceeding with treatment, or not? The author does advocate aspiration prior to injection to prevent intravascular complication(s); this has not been definitely proven and holds no value if a blunt cannula is used due to the length of the device. The use of hyaluronidase is briefly mentioned; yet, the author does not discuss any empirical evidence for off-label dosing in this context.

Managing dermal filler complications part 4: impending necrosis.
Brackenbury J.
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Anna Baker

BJN Aesthetic Nurse of the Year 2016.

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