SEP 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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A n y t h i n g t h a t r e d u c e s s w e l l i n g p o s t - t r e a t m e n t i s o f g r e a t v a l u e . " Dr. Siperstein fi nds that most medications that contain vasoconstrictors can be helpful, such as topical epinephrine added to numbing cream. "Even topical Afrin, which is known to help with nose bleeds, has been hypothesized to help reduce the potential for bleeding," she says. "Vasocon- striction treatments shrink the blood vessels—the smaller they are, the less likely they will be hit by a needle, and less blood will fl ow into surrounding tissue." Injection Technique Ten years ago, Dr. Siperstein would tell her patients there was a 50/50 chance they would have a black eye after their tear trough treatment. But with newer techniques, such as using a cannula and vein fi nder, her bruising rate is now less than 1 percent. First, she uses a vein fi nder to ensure she is injecting in an area free of blood vessels; then she pierces the skin with a needle and inserts the cannula through the opening. "This technique results in a much lower potential for bruising," she says. "Unfortunately, this technique cannot be used for fi ne lines, but it is great for volumizing." JoAn Monaco, MD, of Plastic, Reconstructive & Cos- metic Surgery in New York City, often uses a cannula for fi ller injections. "I particularly prefer using cannulas over needles when injecting the tear trough and the delicate skin under the eye and lateral canthus," she says. Even with cannulas and vein fi nders, bruising can hap- pen, notes Dr. Greenberg. "We are sticking a needle in the face," he says. "But I've found injecting slowly helps." Dr. Tedaldi agrees. "The speed of the needle's or can- nula's exit from the skin is the most important variable. The slower the better." During injection, Sheila Nazarian, MD, of Nazarian Plastic Surgery in Beverly Hills, California, reminds her patients to breathe. "Sometimes patients will tense up and bear down. It's similar to when you bear down on the toilet. Your face gets red because you're opening up all those blood vessels in the face. So it's really important to remind patients to breathe so they don't get red in the face as you're injecting," she says. If any bleeding occurs during injection, Dr. Siperstein has her assistant immediately apply pressure to the area for fi ve minutes to minimize the risk of bruising. "I always explain to patients why I am having my assistant hold pressure, and they are always very appreciative of our making every effort to limit their downtime," she says. Postprocedure Care Postprocedure bruising may also occur due to swelling after the injection that causes the area to becomes con- gested, which can rupture small vessels. "It's not unusual for a patient to leave your offi ce bruise- free and then go home and swell up and wake up with a big fat bruise," says Dr. Tedaldi. "So anything that reduces swelling post-treatment is of great value." 30 SEPTEMBER 2018 | Med Esthetics WITHOUT A TRACE © GETTY IMAGES " Anything that reduces swelling post-treatment is of great value." Immediately applying pressure when a bruise occurs and reminding patients to breathe during injections are two ways to minimize postprocedure bruising.

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