Dr. Patti Flint


Not a day goes by in my office when I don’t shake my head over stories I hear from patients about their experiences receiving “non-invasive” treatments to their faces. There has been an absolute explosion in patient interest in these treatments, including Botox and filler. When performed expertly the results can be truly stunning, however, when performed inexpertly disastrous consequences can occur.

It truly surprises me how cavalier some patients are in choosing someone to perform their non-invasive rejuvenation treatments. They will research surgeons to the nth degree, but when it comes to non-surgical procedures, they will let someone they just met at a med-spa inject them without any discussion about credentials, training or experience. I suppose this comes from the fact that the words, “non-invasive” sound innocuous. Hence the tremendous appeal and popularity of the treatments! However, when I am performing injections in my offices, I am on high alert and at the same degree of attention as I am when I am operating. Here is why.

Fillers are injectable compounds that in my practice are always made of hyaluronic acid. They can be used to provide volume in areas of facial atrophy such as the cheeks and jaw-line or they can be used more superficially to assist with furrows and folds such as in the naso-labial folds or marionette lines. In my opinion it requires an in depth knowledge of facial anatomy to administer these products safely. If they are errantly injected into a blood vessel, tissue loss or blindness can occur. Providers of these products need to have a crash cart of products used to treat filler emergencies such as blocked blood vessels. Many providers do not keep these products on hand because they are rarely needed and are very expensive. Make sure to ask about the emergency contingency plan for treatment.

It took me years of residency training to learn about appropriate facial proportions and to be able to recommend treatment plans that provide durable and natural appearing results, not to mention the considerable time it took to develop the skills required to safely and artfully inject patients. I am never sure how or why an injector trained in a spa or an RN for that matter who has taken a few injector courses would feel comfortable evaluating a patient’s facial anatomy and structure and treating them without the input of an MD, preferably a surgeon. Surgeons simply know the anatomy better. Few would argue that point.

When you meet with anyone who is planning on injecting your face, they should take a thorough medical history to insure you are a good candidate for treatment. You should be told pre-treatment to hold any medications or preparations that can increase the incidence of bleeding and bruising such as aspirin, fish-oil, Vitamin E, herbal preparations etc. If you are on a prescriptive blood thinner such as Plavix or Coumadin it should be determined in conjunction with your physicians if the risk benefit ratio of holding them is advantageous or not. If you are advised to continue them, you should be prepared that more bruising is probable, although temporary.

Prior to treatment the injector should discuss the proposed treatment products and where they are going to be injected as well as potential risks at length. You should be given ample time to ask questions. A written fee quote should be provided. Photos should be taken so that your improvements can be recorded for both you and the injector’s benefit in planning further treatments down the road. Topical numbing cream and ice should be applied prior to treatment to minimize discomfort and bruising and maximize results.

Prior to injections, the numbing cream should be removed and a topical prep solution should be applied. Alcohol swipes alone are not adequate to disinfect the skin when filler is going to be injected. Filler infections are rare, but can be difficult to treat when they occur, so all appropriate precautions should be taken. Post-treatment verbal and written instructions should be provided regarding limiting athletic activities for a few hours. I feel a routine for topical ice application and massage to reduce inflammation should be discussed. After injections, I have my nurse apply SkinCeuticals anti-oxidants and sunscreen to speed your healing and protect your newly treated skin. Your provider should make recommendations for scientifically based skin care products to further maximize your results. You should be given the opportunity to call at any time if you have questions or concerns about your results. If bruising occurs, you should be offered BBL treatments to break up the bruise faster.

If you have had previous experience with injectable treatment and your experience was different than what is outlined above, you may wish to start asking your provider some questions. I have provided a checklist below to keep you on the safe side. Filler and Botox injections in Scottsdale can seem a little like the Wild Wild West if you are not careful. My advice to you is to seek an experienced surgical injector and not to shop price. The piece of mind you will obtain and the quality of your results will make you happy you did.

Botox and Filler pre-treatment checklist:

Were instructions provided prior to treatment to stop taking agents that can increase bruising?

Did the injector perform a complete medical history?

Did the injector explain the recommended treatment plan and answer all questions?

Did the provider discuss risks and treatment of complications?

Did the injector have emergency treatment products on hand and a protocol that is followed?

Is the neuromodulator used (Botox, Dysport) diluted according to the manufacturers recommendations?

Was a clear and complete written financial quote provided?

Was the policy of the cost of possible touch-up treatments provided?

Were pre-treatment photographs taken?

Was topical numbing medicine and ice provided to increase comfort and decrease bruising?

Was a thorough prep of the skin completed prior to injection?

Were verbal and written post-treatment instructions provided?

Were topical agents applied after treatment to protect the skin and aid healing and recovery?

Were post-treatment home products provided to minimize swelling and bruising?

Was education provided on a topical skin care maintenance regimen to maximize results?

Were IPL or BBL treatments offered if bruising occurs post-treatment?

Was a phone number provided to call if questions or concerns arise?

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