Hyaluronidase & Vascular Occlusion Update 2019

In April 2014 I wrote a blog post called ‘Holy Shit, It’s Filler Blindness!’. I felt at the time that the post was needed as there was a lot of fear in the industry about the newly infamous filler-related ischamia of the skin or retina, potentially resulting in the need for a skin graft or even worse, sudden, irreversible blindness. My post was based upon the ‘Expert Consensus…’ (see below) and we went on to use their proposed protocol, with some adaptation as the basis of our hyaluronidase / hyalase assessment station on our training courses. The blog post still gets more hits than anything else on our websites, BUT, ‘expert advice’ has changed regarding the management of dermal filler-related skin ischaemia and blindness since then, and also, we now have a peer-reviewed and evidence-based document. Here’s a quick update (skin ischaemia > blindness). QUICK LINKS: CONSENT FORM for hyaluronidase AFTERCARE SHEET for hyaluronidase February 2014 Aesthetics Complications Expert (ACE) Group. The Use of Hyaluronidase in Aesthetic Practice Summary: Use 1.5-30 units hyalase for skin ischaemia, depending on the size of the effected area. March 2014 Expert Consensus on Complications of Botulinum Toxin and Dermal Filler Treatment. Inglefield, Collins, Duckett, Goldie, Huss, Paun, Williams (March, 2014). Part funded through an unrestricted educational grant from Merz Aesthetics UK). Not available online. Summary: Use 30 units of hyalase for all incidences of skin ischaemia. 4 years ago (no date recorded). Facecoach: Dissolving Hyaluronic Fillers A video explanation March 2017 Aesthetic Surgery Journal, Volume 37, Issue 7, 1 July 2017, Pages 814–825 Summary:Use 500-1500 units hyalase for skin ischaemia, depending on the area of skin affected. Larger...
Body positvity and the Aesthetic Industry

Body positvity and the Aesthetic Industry

Usually the words ‘body positivity’ and ‘self-love’ don’t come into the same conversation when discussing cosmetic surgery or aesthetic treatments. There are many articles telling women to love what they see in the mirror, but that comes with judgement, ‘if you don’t love what you see, and if you do something about that, you’re not authentic’. This stigma revolving around plastic surgery and aesthetic treatments usually holds women back from doing what they want with their own bodies. This should not be the case, loving yourself means doing want you want even if it means going against convention. You can still be confident in your own skin and undergo aesthetic treatments and explore cosmetic options, whether that be colouring your hair or getting lip injections – both choices stem from wanting to enhance your natural features. At Visage Aesthetics we believe getting cosmetic surgeries and aesthetic treatments are wonderful, they can be extremely powerful and transformative in helping people view themselves in a better light. Just make sure you are doing it for the right reasons, and you are only doing it for you. I will finish this blog post with saying, don’t worry about other’s opinions, as your cosmetic surgery or aesthetic treatment was not done to receive others validation. What you choose to do with your body is completely your choice and you should love yourself as well as your...
Can my Client on Immunosuppressants get Aesthetic Treatments?!

Can my Client on Immunosuppressants get Aesthetic Treatments?!

We have the general day-to-day Q&A’s as practitioners, prime example being “I’m pregnant, is it safe for me to have anti wrinkle treatment?” but then every so often we stumble upon clients in slightly more rare circumstances than the usual and it’s why we have a thriving practitioners group on Facebook where expert opinions, advice and knowledge is shared from practitioner to fellow practitioners. Recently someone posted the following question: Can a patient on immunosuppresants for a kidney transplant, receive anti-wrinkle injections and / or filler? We think this answer to this case, although rare, is something that is worth sharing outside of the group, so here it is! The issue with this clients situation is that they are on immunosuppressants to stop their body rejecting the transplanted kidney. From the outset we know anti wrinkle injections isn’t an issue – we don’t think many practitioners would disagree with that. However, Dermal Filler treatment is potentially an issue as it remains in the body for 6-18 months, depending on the product and the area injected. If an infection develops with filler, it can be tricky to treat, requiring several strong antibiotics for a long period. Filler infection is fairly rare, but I  have seen it twice and it can be difficult for the patient to cope with because of the side effects to the antibiotics and due to the fact that the face gets inflamed which can’t be covered up. Being on an immunosuppressant makes it more likely that they could get an infection. So in summary, we say – yes to anti-wrinkle injections and maybe to filler. As...
The Nefertiti Facelift & Working with Platysmal Bands

The Nefertiti Facelift & Working with Platysmal Bands

Did you know that you have four Platysmal Bands? You have two on each side. What are Platysmal bands? Wikipedia describes Platysmal muscle this way – “The platysma is a superficial muscle that overlaps the sternocleidomastoid”… The platysmal muscle covers the upper part of the chest and shoulders rising to the sides of the neck. So now that we’ve cleared that up… we can imagine the process of aging in this area which is situated below the jawline and along the neck area. Usually we picture the aging process as the skin ‘drooping’ and loosing elasticity. However the same is not to be said about the Platysmal Bands – these bands actually tighten over time which forms prominent lines at the front of our necks. Enter the Nefertiti Facelift. It is most common for only one or a couple of the bands to become more prominent, causing the tenting out at the neck which affects the cervico-mandibular angle (the angle of your chin to neck). So how do we treat this problem area for so many? We hear from Dr Michael Aicken, founder of as well as trainer and practitioner at Visage Aesthetics U.K. – First up:  “Ask your patient to tense up and relax from the sides and identify which one(s) are causing the issue…” Next:  “Inject Anti-wrinkle toxin down the muscle band, directly into it by grabbing it like a rope between your finger and thumb. No anaesthetic cream is best as then it isn’t slippy,  (this area is not usually tender anyway). 4 units Anti Wrinkle Toxin (Allergan) or 5 graduations of a 1ml insulin syringe if you trained with Visage Academy /...
SIX Reasons to Train in Aesthetics

SIX Reasons to Train in Aesthetics

Interested in taking the plunge and delving into the arena of Aesthetics? Need a little bit more convincing? We get it! That’s why we’ve put together SIX irresistible reasons to give you that nudge we know you’re looking for!   1) Global medical aesthetics is expected to reach USD 26.53 billion by 2024 from USD 10.12 billion in 2016. In other words you would be investing in a future within an industry that is ultimately – booming. 2) The opportunities just keep on coming. Once you finish and pass your course, you’re immediately certified in the use of Anti-Wrinkle Toxin and Dermal Filler. With adequate insurance, you are set! You could start up your own private clinic or partner with a local salon, whatever you think is best. Heck you might even want to consider a ‘mobile business’ bringing your services to people in the comfort of their own home! 3) Mannequin heads only go so far. At Visage Academy we offer simulated clinics with REAL patients as part of our courses. The opportunity to practise all treatments (Anti-Wrinkle Toxin and Dermal Filler) on real patients is second to none and will put you in good stead for the future. 4) Lucrative profit margins. The amount commonly charged by practitioners for treatments is more than double the cost necessary to purchase Dermal Filler and Anti-Wrinkle Toxin. 5) You can count on us. It’s not as if once you complete your training we say our goodbyes and you become nothing but a name on our archive records. No no no, we recognise the need for on-going support and guidance, this...

Large Swelling Immediately After Dermal Filler Treatment

Imagine that you have just injected a patient’s lips or cheek. Suddenly, the area swells up like nothing you have ever seen before. It’s an unfamiliar sight… you panic… you vaguely remember about some of the rare but catastrophic complications of dermal filler. You reach for your emergency filler pack. Should you do that? Are you sure? Skin ischaemia is now a complication of dermal filler treatment that most practitioners are aware of but thankfully, few have experienced it first hand. With an estimated incidence of 1 in 1 million, in an industry still experiencing record growth rates, the occurrence of dermal filler related skin ischaemia and many other complications are bound to increase. Haematoma formation (a large, swollen bruise) is another, more common and less severe complication of dermal filler; one that differs from skin ischaemia is almost every possible way, is frequently being misidentified as skin ischaemia by aesthetic practitioners from various medical and non-medical disciplines. Whilst it is vitally important that aesthetic practitioners identify skin ischaemia and take action if they suspect this, it is also important that misdiagnosis is avoided so that perceived rates of skin ischaemia are not inflated and that unnecessary stress is not brought upon these practitioners and their patients. So, what’s the difference? Ischaemia would be white and painful and not associated with swelling. If you see swelling develop before your eyes, you may have hit a blood vessel, causing a haematoma / large bruise. It may not look discoloured like a bruise *YET*, but this may just be because the bruising is so deep that you can’t see it through...