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Understanding Cosmetic Procedure Complications: Insights from Experts
Welcome to Skinside Out, where Science Meets Beauty. Join Dr. Zain and guests Heather, Courtney, and Crystal as they talk about the complications associated with aesthetic procedures. This episode focuses on various injectable complications, including intravascular occlusions and the importance of correct filler choice. The team also addresses complications with lasers and energy-based devices, sharing real-life cases and the importance of proper training and protocol. Learn about the importance of technique, pre- and post-procedure care, and the necessity of managing complications effectively. Tune in for an insightful discussion on navigating aesthetic treatments safely.
00:00 Introduction to Skin Side Out
00:42 Understanding Injectable Complications
03:03 Common Side Effects and Misuse of Fillers
07:26 Neurotoxin Complications and Importance of Expertise
08:43 Laser and Energy-Based Device Complications
13:09 Challenges with Morpheus Eight and Microneedling
14:11 Importance of Pre- and Post-Procedure Protocols
16:55 Complications with Chemical Peels
18:14 Handling Complications in Real Time
20:11 Injectables and Vascular Occlusions
24:17 Respecting Skin Anatomy
25:20 Complications in Medical Spas
27:11 Final Thoughts and Future Discussions
Welcome to Skinside Out, where Science Meets Beauty. Join Dr. Zain and guests Heather, Courtney, and Crystal as they talk about the complications associated with aesthetic procedures. This episode focuses on various injectable complications, including intravascular occlusions and the importance of correct filler choice. The team also addresses complications with lasers and energy-based devices, sharing real-life cases and the importance of proper training and protocol. Learn about the importance of technique, pre- and post-procedure care, and the necessity of managing complications effectively. Tune in for an insightful discussion on navigating aesthetic treatments safely.
00:00 Introduction to Skin Side Out
00:42 Understanding Injectable Complications
03:03 Common Side Effects and Misuse of Fillers
07:26 Neurotoxin Complications and Importance of Expertise
08:43 Laser and Energy-Based Device Complications
13:09 Challenges with Morpheus Eight and Microneedling
14:11 Importance of Pre- and Post-Procedure Protocols
16:55 Complications with Chemical Peels
18:14 Handling Complications in Real Time
20:11 Injectables and Vascular Occlusions
24:17 Respecting Skin Anatomy
25:20 Complications in Medical Spas
27:11 Final Thoughts and Future Discussions
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
018 Skinside Out - Complications in Aestetics
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[00:00:00]
Dr. Zain Husain, MD: Welcome to Skin Side Out where Science Meets Beauty. I'm your host, Dr. Zane with Heather, Courtney, and Crystal. So today we're gonna be continuing our conversation about complications and aesthetics. So let's dive right into it. So we're gonna talk about injectables. So Heather, do you wanna start? I.
Heather Murray, PA-C: Sure. Yeah. So, um, we'll kind of touch on just different types of complications you can get with injectables. So I think the most common one, or I guess most well known is intravascular occlusion. So meaning if we were to [00:01:00] use a filler or an injectable product and we inject it into the blood vessel, it could occlude the blood vessel and block blood flow to that area.
And there are some really serious, um. Areas where that could, you know, lead to blindness, tissue necrosis. Um, we've seen it a lot in the office, unfortunately. Um, but the nice thing is there is a way to reverse it. So in the office
Dr. Zain Husain, MD: from other offices? Yeah, yeah, yeah, yeah. Sorry. That's what I meant.
Heather Murray, PA-C: Coming to us from other places, having that complication.
So it, unfortunately we've seen it, you know? Multiple times from those practices, but, but, um, the nice thing is we can use a product called Linx, which helps to kind of dissolve that filler and, um, break up that occlusion.
Dr. Zain Husain, MD: it's important to know that it's not. Like, oh, it's gonna be definitely reversed.
Right. There's a time factor, right? Yeah. So if there [00:02:00] is a significant amount of time that has gone by, the tissue's not getting oxygen, yeah. It can lead to permanent, you know, necrosis and mm-hmm. Other issues.
Heather Murray, PA-C: And typically it'll form as like this discoloration, whether it's like. This blanching effect, so like a, a wider appearance to the skin or like even a grayish hue.
Mm-hmm. Um, it really kind of depends on how involved it is. Mm-hmm. Um, but it could get bad pretty quickly, so
Dr. Zain Husain, MD: Yeah. And then you can even get blindness, right? Yep. So if you're injecting a certain vessels that have circulation that feeds the, um, you know, the blood supply to the eye, you can get blindness.
Heather Murray, PA-C: And that's, uh. A big thing because there's not a lot of pathways that supply blood to the eye, and so if you're blocking that mm-hmm. There's no way around getting blood to that area.
Dr. Zain Husain, MD: Yeah. So intravascular occlusion, definitely one of the scariest, um, complications we see with filler. [00:03:00] Any other injectable complications that we see?
Heather Murray, PA-C: I guess I wouldn't really call this a complication. Mm-hmm. More just like a side effect, but like bruising and swelling. Mm-hmm. Those are pretty common.
Dr. Zain Husain, MD: Yeah.
Heather Murray, PA-C: Um, also using the wrong fillers in, um, certain areas. So if you're using a very. Thick, viscous filler for somewhere that needs more movement.
It's gonna look funky. It's not gonna move when your tissues want to move. Um, I had a patient also too, just going into like lip fillers for example. Mm-hmm. There are a lot of different lip fillers that you can get. Some are give you a more subtle look and some give you more like juicy Plumpy look. And this patient really wanted.
A very subtle, natural enhancement of her lips and they gave her a product that is very well known for mm-hmm. Giving you that juiciness. And so, you know, she told me that she had that product and I was like, well that's, that's why, unfortunately. So I think really. Going to somebody who has that expertise and knows what [00:04:00] failure should be used where, but also what product gives, what result.
Dr. Zain Husain, MD: Yeah. And I've even seen issues where the wrong type of product was injected. 'cause some of these products look the same. Right. So there was a practice that, um, you know, I was, you know, I was observing, um, I think I was in training. The nurse handed over Ella instead of Botox.
Heather Murray, PA-C: Stop. Oh, oh my God. Oh, I have a story too.
So
Dr. Zain Husain, MD: not only was it crazy painful and swelling, but it actually caused a little bit of skin. Necro an ulceration. So, yeah. And then they realized what happened. I
Heather Murray, PA-C: very similar story, this didn't involve me at all, but a medical assistant had drawn up candida instead of Botox. Oh. And so candida is actually a yeast that we use to inject in warts and that causes your immune system to respond and fight the virus off.
Um. So they [00:05:00] injected her whole forehead with candida, swelled up, got really red, very uncomfortable. Thankfully she was okay. But it was, I think, a little bit of recovery on her
Crystal: end too. I witnessed that same thing, that it was mixed strong, and the patient immediate was like, oh my gosh, why is my forehead burning so badly?
And you know, they're like. I don't know what you're talking about. Yeah, you're fine. You're fine. Like it's normal. But until later, they tested it on themselves and she was like. Okay. Yeah. No, this is not mixed. Right.
Courtney Carroll, LE: That's crazy. I can't wrap my head around that. I believe it. I just knowing it myself. I'm like, that's crazy.
Yeah,
Dr. Zain Husain, MD: yeah. I know. Mistakes happen. Yeah, but that's why it's big. So important. I know. I know.
Courtney Carroll, LE: Ella. I mean,
Dr. Zain Husain, MD: oh, imagine that.
Courtney Carroll, LE: No, as someone that got in her jaw, like that's, that was good. [00:06:00]
Dr. Zain Husain, MD: Um, any other complications that you see with injectables?
Courtney Carroll, LE: tox, fortunately it does wear off, but like you, we see from time to time injectors who are placing it like incorrect too.
Superficially. Yeah. You know, either you get the spot eye or your, or you're dropping the brows. The ptosis. Mm-hmm. Yeah. It's, and you know, so it's all, again, it's all about placement or, you know, same thing with the lip flip where they're placing it. Mm-hmm. Might bring your lip out. Right this way instead of that way.
Yeah. I mean it's just wrong placement, I think, in general.
Dr. Zain Husain, MD: Yeah. So that goes, um, you know, along with training technique. Yeah. Education, you know, and
Courtney Carroll, LE: knowing the anatomy.
Dr. Zain Husain, MD: Yes. I mean, those weekend courses or half day courses, they don't cut it. Yeah.
Courtney Carroll, LE: Well, and by the way, for those weekend courses, they choose easy models.
Yeah. 'cause you are training. So, and they also dilute
Heather Murray, PA-C: the products too. Yeah. So you're getting, I think you get a little bit of that. I guess experience injecting. Mm-hmm. But you're not feeling how those products are actually injected. Mm-hmm. 'cause they're diluted, right?
Dr. Zain Husain, MD: [00:07:00] So I mean, those are, you know, the complications that we unfortunately see in real life.
And they are real complications and not all of them are reversible. Mm-hmm. And, you know, once they cause permanent destruction, um, you can have scars that are very difficult to treat. And you end up spending a lot more kind of correcting the complications than you did trying to save a few bucks, you know, going to somewhere that was less reputable.
Heather Murray, PA-C: I guess. We talked mostly about filler for injectables. Mm-hmm. But there's also a lot of, a lot of other complications with neurotoxins that mm-hmm. I. Don't think we really touched on, but just like similar kind of thing. If you inject into the wrong place, it could lead to like a lid lag or it could drop your brow.
Mm-hmm. And stuff like that. Yeah. So definitely knowing that anatomy and knowing where the muscles are.
Dr. Zain Husain, MD: Yeah. And then also like I. Making sure that you're reviewing the patient's medical chart and allergies because there are certain neurotoxins, like if you have a cow's milk, protein allergy or [00:08:00] albumin, like there's some of them that have albumin and other, um, proteins that can cross react and you can develop a reaction and that's always something that you wanna avoid, especially if it's something preventable and you looked at their history.
Courtney Carroll, LE: Mm-hmm. Autoimmune conditions is another big one. I think, you know, a lot of, um, times. There can be practices that kind of skip over that. And I think it's, um, important to know as a injector. Um, yeah. I mean, cosmetic
Dr. Zain Husain, MD: treatments are medical treatments, so people tend to like poo poo them. Like, oh, it's just like, you know, I'm gonna look good and Yeah.
You know, it's just a very low risk procedure, but they are medical procedure at the end of the day. Mm-hmm. And there are true risk and ramifications for things that go wrong.
Courtney Carroll, LE: Mm-hmm. Yeah.
Dr. Zain Husain, MD: we obviously see a lot of injectables. We see a lot of lasers and energy based devices.
Courtney, um, what have you seen, um, as common complications?
Courtney Carroll, LE: So I feel like laser hair removal, reduction and IPL tend to be the biggest. Mm-hmm. Um, you know, [00:09:00] offenders. Um, I think, you know, as we've mentioned before, with there being so many different. Settings that you can use on the laser. So many different type of, uh, of wavelengths, uh, different skin types that you're seeing that, you know, getting that history on the patient.
Okay. Have you been out tanning the last, you know mm-hmm. Six weeks? Uh, for example, with the laser hair, I can't tell you how many leg burns I've seen. You should know in the summer, no one is completely sun free. Like I, at this point, I kind of joke about it, but I also, I like do not treat legs in the summer.
I refuse like, eh. I have just seen so many burns with the laser and they will look like, um, these little circular, sometimes half moon.
Heather Murray, PA-C: Mm-hmm.
Courtney Carroll, LE: Um, and or what I've also seen, which I, you know, no one is perfect. I know my overlaps are not perfect either, but you'll see these like pictures of these burns that are like spaced apart, like four inches.
So even if they didn't get burned, they still are missing like gaps of skin for the hair.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: So I, I think those are the biggest offenders and you know, with the [00:10:00] IPL, again, it's, it's not a device that's safe for all skin types. So, you know, I had a, I had a, a statistician one time refer a patient to me who was Hispanic and, you know, she was very upset that I would not do the IPL on her that day.
Mm-hmm. But. She understood when I told her that the risk of burning her was incredibly high, and I hated to be the messenger, but you know, let's get you back for something else. But
Dr. Zain Husain, MD: there are places that will happily treat that person. Yeah. I
Courtney Carroll, LE: almost got a
Crystal: CO2 laser one time. Yeah. Oh geez. And then before learning that it wasn't meant for my fit patch.
Courtney Carroll, LE: Well, I just had a patient last week. I saw a. Sweet young girl. She, um, you know, has really bad rosacea. First of all, she was like, I don't know if I have rosacea because I am Hispanic and mm-hmm. Latin, you know, and I said, well, it's definitely rosacea. Mm-hmm. Um, and then, you know, she said that this other place in the area had recommended IPL for her.
And I said, girl, like, no, like, and she said her gut feeling just it wasn't right. She went home. Mm-hmm. Good, smart girl. She googled it. Can I do IPL with my skin type? Is this. It [00:11:00] said not recommended. Mm-hmm. You know, she came to see us and we talked about the yag but um, yeah, you, you just, there is such a high risk of burning someone if you don't know that skin type and you're not experienced with that
Heather Murray, PA-C: device.
I think the most common, um, lawsuit in dermatology is from lasers. Yeah. Burning. Agree. Laser
Dr. Zain Husain, MD: hair removal specifically. That's the highest, um. In any procedure in aesthetic.
Heather Murray, PA-C: Mm-hmm. And a lot of people think, oh, it's such an easy procedure, anybody. It looks easy. Yeah. It looks easy.
Dr. Zain Husain, MD: There's science behind it.
Yeah. There's reasons why there's so many different devices. And unfortunately, some offices don't offer the right devices for all the, you know, skin of color patients that they have. Mm-hmm. And they just don't wanna turn away business.
Courtney Carroll, LE: And then, but then that's where you get. As mentioned before, that under treating, because they would rather undertreat and continue to take that money than accidentally burn someone.
Mm-hmm. So you have these texts that have no training and they're like, oh, well I'm just gonna use the preset settings, the lowest setting possible, and just keep going. And then people as another [00:12:00] complication can get this paradoxical, um, hypers, hypertrichosis where they're actually having increased hair growth and that's not what you want.
But those patients are so
Dr. Zain Husain, MD: mad, like you have this lady trying to cheat her facial hair and like growing a beer.
Courtney Carroll, LE: Yeah. Yeah.
Dr. Zain Husain, MD: A thicker beard.
Courtney Carroll, LE: Yeah. So it, it's, you know, you, that's why Yeah. Settings are so important. Training is so important. Um, with, with the lasers.
Dr. Zain Husain, MD: what about energy-based devices?
Have we seen any complications specifically with radio frequency microneedling?
Heather Murray, PA-C: depending on the device and depending on the depth that you're using mm-hmm. You can see, um, some fat loss
Dr. Zain Husain, MD: mm-hmm.
Heather Murray, PA-C: In areas that you might not want that. So like the cheeks, we want that volume to stay in our cheeks.
So if you are using a depth that is not appropriate for that area. It could cause that fat to almost atrophy. Mm-hmm. And then, then you're left needing filler to fill that area. So you're just treating, it was just a cycle. Mm-hmm. Exactly.
Dr. Zain Husain, MD: And specifically with the Morpheus eight device. Yeah. I've been hearing a lot of issues with patients being previously treated.
And that is, [00:13:00] that used to be the hottest device on the market. Oh yeah. Yeah. Everybody knew everyone needed to have it morph. Do you guys have Morpheus eight? No. Like, I'm not coming here. Yeah. I'm like, okay. Um, but yeah, Morpheus eight. Um. You know, I know they've, they've had their challenges because they're very aggressive treatments and can cause that fat loss like you were talking about.
Mm-hmm. And people are looking worse than when they had prior to having the, uh, procedure, so, right.
Courtney Carroll, LE: Even traditional microneedling, I've seen, um, people who have those like tear marks. Mm-hmm. So, um, like almost like the, the needles were dragged across the skin mm-hmm. Rather than. You know, use a, in the channel.
Yeah. It almost looks like there was no glide that someone just like dragged this device across. I mean, there's lines and everything. And so I, I've seen that before. Um, people who do microneedling and, um, go too deep in the skin. Um, and the, the pressure that they're using. 'cause some people use like a stamp method where instead of actually creating a [00:14:00] glide and circling, uh, in their motions, they will stamp, stamp, stamp.
But what happens is they stamp too hard. Mm-hmm. And then. You get that risk of scarring. That's how the Morpheus eight
Crystal: is. Mm-hmm. Uh, is the stamping, so. Yep.
Courtney Carroll, LE: Yeah. Yeah.
Dr. Zain Husain, MD: So, you know, another thing that this, um, kind of brings to mind is how important pre and post procedure mm-hmm. How important it's to have.
Mm-hmm. Protocols so that patients get optimal results and not have complications. So like for instance, like patients who are, you know, getting chemical peels or certain lasers, especially those that have hyperpigmentation or skin of color. You know, sometimes I pretreat with brightening agents such as hydroquinone, um, and other like tretinoin to help reduce the chances.
Of you getting hyperpigmentation and then post procedure, being really focused on sun protection, um, when to start incorporating active, um, ingredients for your skincare. Um, and just making [00:15:00] sure that the patients understand and, you know, for ablative treatments or like really aggressive treatments, you know, I often have prophylaxis for, you know, viral.
Fungal and bacterial infections so that mm-hmm. My patients don't encounter any of those issues post procedure. 'cause those are terrible. 'cause your skin's open and you get those infections. Um, it can cause more issues like scarring and, you know, other issues.
Heather Murray, PA-C: Yeah. Um, my mom actually had CO2 completed by Dr.
Zane last year and her. Aftercare was set up very, very well. And she did phenomenally. But at the same time, um, my best friend's mom was having CO2 completed somewhere else, and they told her to just let the skin dry out. Don't do anything. Don't do, don't put anything on it. Oh God. Face, neck, and kind of chest area.
Mm-hmm. And you know, it's. It's awful to hear that because she had pink scars in that area for months afterwards because she was just doing what they told her to [00:16:00] do and she, you know, she thought their expertise and their knowledge was,
Dr. Zain Husain, MD: yeah,
Heather Murray, PA-C: you know what, she should go by.
Dr. Zain Husain, MD: How did she end up doing?
Heather Murray, PA-C: She is, I think she's fine now.
I haven't seen a picture of her recently, but um, I think she still had some like leftover, like you could see the square of the device Yeah. Stamped on her chest. Yeah. So I think. After she, her, her, um, daughter sent me a picture. I was like, why is she not putting anything on? I know, I think at that point she was probably post day four or five, so I think she started putting stuff on after that, but,
Dr. Zain Husain, MD: and it's so critical to.
Be on the proper protocol early on. Mm-hmm. Yeah. Because it really helps with the results and facilitates healing.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: You know, by not following those protocols, you can like drag this out like four times longer.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: And also have risk of hyperpigmentation. Yeah. Other issues that it's kind of not needed.
Heather Murray, PA-C: Yeah. Yeah.
Dr. Zain Husain, MD: Um, so we talked about lasers, energy based devices, [00:17:00] anything else that you can, um, you know, you typically see as complications.
Heather Murray, PA-C: I think we briefly touched on like post chemical peels, like the biggest thing being hyperpigmentation, especially for people who are more sensitive to that or skin of color.
Courtney Carroll, LE: Well, just going off of like peels too. Um, you know, I think. Like Dr. Zane had mentioned prepping people for peels. Like, you know, I've worked with, um, some providers that don't believe in hydroquinone and they think it's like the devil's work. It's, it blows my mind. Um, so, you know, it's, it's funny when like.
Patients will come to me and be like, oh, well, I, I don't know that I wanna use hydroco. They get so nervous about it and I'm like, this is our safety net. Mm-hmm. Like, it makes me feel more comfortable. It will make you feel more comfortable. It will, you know, better the outcome of your peel. Um, so by suppressing like, you know, that pigment in the skin, you will limit that risk of hyperpigmentation after the peel.
Um, things like steroids, I know sometimes we'll utilize too [00:18:00] for post peel. Um mm-hmm. Just to optimize the, the results and again, help with that post-inflammatory hyperpigmentation, especially in people with skin of color. So I think those are all, you know, important adjuncts to your treatment to minimize those complications.
Dr. Zain Husain, MD: Yeah, and I wanna kind of talk about how. Complications can happen to anyone. Mm-hmm. Even the most experienced injector. So I'm not saying that it's not gonna happen to me, um, it's bound to happen at some point, but it's how you treat the complications. Mm-hmm. And having that ability to do that in real time.
'cause time really equals your skin health at that point. If you wait and delay treatment, you can have poorer outcomes. So that's why. Yeah, you can maybe do the procedure, but if you don't know how to treat the complications, you have no business doing it.
Courtney Carroll, LE: I'm so glad you mentioned that because very early on, when I first started doing glycolic peels, which glycolic peels are pretty minimal, you know, I.
There are people that can have reactions [00:19:00] to them. I think that's why it's important to start low. I'm always gonna start at a lower percent, but with this patient, it was probably my first few months, um, of doing aesthetics and she had a wedding coming up, so she just wanted to do like a light peel and she'd never had one before.
So I said, okay, we're gonna do a 20%, that's, you know, as low as we go. And she had a wedding in like three weeks. So again, a normal turnaround on a glycolic feels about 48 hours, you know, so. Ample time, but she had a true allergy to the glycolic. Not a burn, not a true allergy. So she calls me and her face is red, swollen, itchy, and I freak out because I'm like, okay, this is my fault.
I burned her on a 20%. Like what did I do wrong? And anyways, my doctor, um, ended up putting her on prednisone. Uh, you know, especially being so close to the wedding to make sure she was fine at the end of it, you know, she. She comes back after her wedding and she's like, that was the best my skin has ever looked because of the collagen production from the inflammation.
And then the prednisone cleared her acne. So she [00:20:00] literally looked so good and she's like, we should try that again. I said, no, we are not. That gave me a heart attack. I was up for like two weeks straight. Like did I mess her up?
Heather Murray, PA-C: The other thing I was gonna add, just um, going off of that is with injectables, just with that intravascular occlusion, I think.
Yes, it is a very serious. Reaction or complication. Um, and it, uh, unfortunately is very common, but I think a lot of people do say, you know, if you haven't had a vascular accu occlusion, you're not injecting enough. Mm-hmm. And you could aspirate all day long. Oh yeah. And that's a technique that we use to kind of pull back on the syringe to see if we're in a blood vessel, but.
There's always the chance that you're in a blood vessel and you don't know it. Mm-hmm. So I think thankfully we have never experienced that in our practice, but I think it is very common and something to be mindful of. Yeah.
Dr. Zain Husain, MD: I mean, I have aspirated blood before, so clearly I wasn't a blood vessel. Yeah.
And obviously [00:21:00] I, you know, redirected and, you know, everything was fine, but that's always scary seeing that flash of blood.
Heather Murray, PA-C: Yeah, I have too.
Dr. Zain Husain, MD: Um,
Heather Murray, PA-C: yeah,
Dr. Zain Husain, MD: so very scary, but, um, it's humbling and. You know, for patients who you know have heard, oh, a cannula is so much safer than a needle. Yes, it is safer, but the risk is not zero.
To get an intravascular occlusion, you can still get into a blood vessel with a blunt tip cannula.
Heather Murray, PA-C: Mm-hmm.
Dr. Zain Husain, MD: And that's scary.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: But it can happen. Um, but I do find that. I am more confident in that I'm not gonna be in a blood vessel if I used a cannula versus sharp needle. Yeah. But I don't by any means think that the risk is zero.
Heather Murray, PA-C: Mm-hmm.
Dr. Zain Husain, MD: Um, and even with aspiration, like people say, oh, aspiration, aspiration. They've shown that it doesn't always reliably indicate whether you're in a blood vessel. Right. It's. You know, also the gauge of the needle, how much pressure you're using and everything there. And you have to wait
Heather Murray, PA-C: for like 10 seconds.
Yeah. Yeah.
Dr. Zain Husain, MD: Nobody's waiting 10 seconds. Yeah. I mean, I think in [00:22:00] reality, so yeah, let's be real here. I mean, are people really getting a false sense of security, um, by going to these trainings and like, oh, you should aspirate and you know, if you don't see that blood flash, you're good and inject away. So Yeah, it's
Heather Murray, PA-C: not always a hundred
Dr. Zain Husain, MD: percent.
Yeah.
Courtney Carroll, LE: Yeah. And if you have question, I feel like. It's always better to ask your provider, you know, if on the other end of things. Okay. Even though maybe it looks like bruising. 'cause again, that vascular ocion can come off on that dusky kind of purple-ish or gray color. And yeah, sometimes people can con, you know, at home they might confuse that the bruise, a bruising or, you know, so I think it's always, um, a good idea to reach out to your injector and just make sure, Hey, is this normal again?
They're not gonna be bothered by you. Yeah. They'd rather know about any potential complications.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: Um, ahead of time.
Dr. Zain Husain, MD: And oftentimes with vascular occlusions, they're painful. So patients are complaining about pain. Mm-hmm. Mm-hmm. And when I'm examining them, um, you know, you typically don't see that capillary refill with, um, pressure.
Mm-hmm. So that's another sign. So when a patient calls and [00:23:00] they say, Hey, I think something's wrong, and they just had filler, I have them come back in the office just to make sure. And, you know, all the times that I've been called, they've been luckily bruises. Yeah. Yeah. Um, and patients are just scared and like sometimes they have hematomas and like an enlarging bruise.
I feel so much better seeing them in person. Otherwise, I can't sleep at night.
Heather Murray, PA-C: I can,
Dr. Zain Husain, MD: like, I'm thinking about them like, Hey, I need to see you. Like, I've gone back after hours. Hey, patient meets me at the office. I'm taking a look. Um, I don't care. I'd rather them be safe and not suffer a complication. Yeah.
Because
Courtney Carroll, LE: again, time is of the essence with something like that. So.
Dr. Zain Husain, MD: And there are also those devices with infrared light that you can kind of see the vasculature. Have you seen those? The VA mes? Yeah.
Heather Murray, PA-C: Yeah. Seen that. So
Dr. Zain Husain, MD: that's another thing, like people, oh, I'm using that. That's, that means I'm not gonna get into a blood vessel.
Yeah. I mean, you can dodge some blood vessels so you don't get some bruising, but still there are so many little ranches of those blood vessels. So. I mean, I, there's never
Crystal: a 100%. Yeah. Yeah. Never say never.
Heather Murray, PA-C: Yeah. Too, I think [00:24:00] technique, like a lot of times we do this retrograde technique where we may aspirate and see, okay, I'm not in a blood vessel, I'm good.
Mm-hmm. But as you start to pull the syringe out, that's a technique that we use. Mm-hmm. You could be passing through mm-hmm. A blood vessel as you're coming out, so you never know.
Dr. Zain Husain, MD: Yeah. I mean, that's why it's so important to respect the skin. It's an organ. It's our largest organ. It is very complex and the face is super complex.
Like I remember during head and neck anatomy, um, as a first year med student, it was crazy. All the different structures that we had to learn. My little brother's, an ENT surgeon, I still don't understand how he, he does what he does, but it's um, it's, it's very humbling and it's scary. So knowing the anatomy cold.
It's very important, but I'm still scared sometimes. Mm-hmm. And knowing what planes to inject, where you find those structures. And the scary thing is, oh, we learn about this angular artery. Right. But there was a paper that showed that there are four different variations. Anatomical, it could be very [00:25:00] different than where you expect it to be.
Mm-hmm. So there are anatomical variations in mankind and you need to be able to respect that. And not everyone is the same. Yeah. Yeah. Um, so we talked about chemical peels, we talked about devices, um, laser based, um, as well, energy based, and we talked about injectables. Um, so I kind of wanted to segue and kind of talk to Crystal.
She was a manager at a medical spa and, you know, some of the, you know, complications that you saw.
Crystal: So one of the complications that I saw, um, which I had mentioned before, was the laser. Um, we had someone. Come in for a laser treatment and her face ended up getting burnt. Mm-hmm. And a come, uh, upon looking and investigating it mm-hmm.
We found out that the person that did the treatment on her skin wasn't actually licensed. , I've seen only one vascular inclusion and it was very scary. You had to work [00:26:00] really quickly. Um, so thankfully I haven't seen too much. Mm-hmm. Um, but definitely being able to know what you're doing and how to handle it mm-hmm.
Um, is very, very important.
Dr. Zain Husain, MD: I mean, I don't wanna scare everyone, um, in getting cosmetic treatments. They can be done very safely and reliably. I think it just requires some research on your part, making sure that whoever's treating you has the correct qualifications and training and they also understand how to treat complications.
And it's really hard to know that, um, without. Doing some digging on your provider, um, seeing what they've been trained in. And I do think that it's worth the extra time to do your due diligence. Um, and you know, that's why I feel confident in providing great care, um, in my office. And, you know, I have Courtney and Heather, who can help me treat my patients as well.
[00:27:00] But you know, things can go awry. Mm-hmm. And it can happen even the most experienced hands. So. Us being able to manage any complication that come forward, that's just as important as being able to do the procedure. Mm-hmm. it was a sobering discussion. Um, a little scary, but, um, I think it's an important discussion and something that we're seeing more and more of as aesthetics is continuing to rise.
Um, but, you know, I think that we'll have other discussions, um, in the future as more, you know, aesthetic advancements, uh, come about and we learn, you know, more. Issues that come up with new technologies, new, um, you know, treatment options. So, you know, stay tuned. This is an evolving science, but we'll be hopefully giving you some updates as we go along.
Um, so this wraps up our episode. Hopefully you liked it. Um, hopefully, you know, you found it insightful. Um, please follow us, like us. And until next time, skin side out out,
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