Expert Consensus on Complications of Botulinum Toxin and Dermal Filler Treatment

01 Jun 2014

We speak to some of the authors of the new complications in injectables document to find out about the reasons and process behind its creation and the plans for future developments

In May 2013, a multi-disciplinary expert group from the Merz Aesthetics Partnership in Practice Conferences came together to discuss feedback gained from these events. This indicated that delegates and practitioners were keen to learn more about handling and recognising complications, and so the expert group, consisting of plastic surgeons, doctors, dentists, dermatologists and nurses, began the process of creating a document that encapsulates this information. 

The group that created the Expert Consensus on Complications of Botulinum Toxin and Dermal Filler Treatment document1 includes plastic surgeons Mr Chris Inglefield and Mr Santdeep Paun, nurses Fiona Collins and Marie Duckett, aesthetic doctor Dr Kate Goldie, dentist Dr Gertrude Huss and dermatologist Dr Stefanie Williams. 

On the necessity of the document, Duckett says, “There didn’t seem to be any document that you could go to. In clinical studies, the majority of information will focus on the findings and then there may be a couple of sentences at the end on complications. Most of the time we’re dealing with the face so complications, no matter how small, are significant. Practitioners want to deliver treatments with a minimum amount of distress to the patient, and major distress for patients occurs when they suffer complications, even if it is just plain bruising; sometimes a bruise can be a significant event.”

The group spent six months collating research articles from various sources for the document and, with the help of a medical writer and an educational grant from Merz Aesthetics, published their findings in March 2014. The document was then dispersed at a series of regional conferences In London, Manchester, Edinburgh and Dublin. 

Although Merz provided the funding in order to publish the document, Duckett emphasises that it is an independent piece of work. Mr Inglefield says of his reasons for taking part in the project, “Our goal was to bring together specialists from all backgrounds who are passionate about safety in our industry. We recognised that there was incomplete or absent recommendations for the management and reduction of adverse events in toxin and filler treatments. Our aim therefore was to produce a consensus document which provided practitioners of all levels evidence-based recommendations.” 

Duckett adds, “Nowadays, we inject wider areas of the face than we did previously. You have to do everything in your power to make sure that every time you pick up a needle or syringe, that you are providing the safest possible treatment for your patient.” 

The document is split into two parts, ‘Recognising and Minimising Complications’ and ‘Complications: Risk Reduction and Treatment’, and includes potential complications and case studies for specific patient complaints such as crow’s feet, forehead lines and tear trough, followed by advice on how to avoid and deal with these adverse events.

You have to do everything in your power to make sure that every time you pick up a needle or syringe, that you are providing the safest possible treatment for your patient.

It also includes an A-Z quick guide of complications at the back of the document. “We’ve tried to make the document very user friendly,” Duckett says. “Anatomical images accompany each section, which clarify exactly what the safe and danger zones are on the face. The A-Z guide acts like a glossary, and for everything that’s covered, algorithms have been included so that readers know what course of action to take. It’s laid out in a logical fashion to help practitioners mark the face, so they know the ideal areas to inject.”

Mr Inglefield adds, “The Consensus document has been developed as a reference and quick guide in the management of adverse events in toxins and fillers. My initial advice is to read through the document to be familiar with all the contents. This can then be used as a quick reference for safe treatment and managing all adverse events.”

The expert group plan to continue their work and produce an updated version of the guide. “We will update the document as new data becomes available,” Mr Inglefield says. “The Expert Group will continue to look at areas where we can produce a consensus document for use by practitioners, for example in the use of needles vs cannulas. We can also provide a go-to resource for opinion from the media, government and industry for both patients and practitioners.” 

As well as updating the document as practices and products develop in the market, Duckett suggests the group will also concentrate on making the document more readily accessible for direct use in practice. “We’d like to increase the indexing and algorithms, to make it easier for people if they need to find something quickly.” 

She also suggests that they may produce a similar document for other treatments in the future. “We’ve just covered botulinum toxin and dermal fillers, but there may be a case of doing something with lasers or radiofrequency,” she says. “This hopefully is not the end of this document and it is something that should evolve.” 

The second edition of the document with further additions is expected to be available in June or July. 

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