Facial aesthetic injectable treatments with neuromodulators, hyaluronic acid fillers and skin biostimulators are well established, with favourable safety profiles and consistent outcomes. Adverse events and complications may occur, as with any medical treatment. Fortunately, the majority of adverse events tend to be self-limiting and mild. Serious adverse events, including extensive infection and intravascular occlusion resulting in skin necrosis and blindness, are rare.
The number of minimally invasive facial aesthetic procedures performed annually continues to exponentially increase worldwide and as a result, complications will increase in frequency. It is vital to consider correct patient selection, full informed consent and treatment planning, preparation and impeccable injection technique as these are important risk reduction strategies.
In this article we will discuss the reasoning behind why marking-up prior to injection treatments is essential. Some clinicians choose to mark injection sites, which is traditionally done with a white pencil. Although optional, many injectors in the industry advocate this technique which can help keep track of the sequence of injections, particularly if the process is interrupted.
At Aesthetic Excellence, we have redesigned how Medical Professionals mark-up prior to their treatments. Our excellence range of Aesthetic Pencil Markers and Pen Markers are premium quality, purpose-designed products for professionals.
Marking should be done before antisepsis, and injections should never be done directly through the marks themselves to avoid risk of tattoo. We recommend an initial cleanse to the skin, followed with marking, and then an additional disinfection stage prior to injecting.
Injecting through a beard or eyebrows is acceptable if those areas have been cleansed thoroughly. Once the injection sites are prepared, an Aseptic Non-Touch Technique (ANTT) should be used, touching the site only with the needle. The sterilised area should not be touched again, except with the needle.
We've designed the acronym "SCARCE" to explain its importance.
SCARCE - Marking-up prior to treatment allows:
1. SAFETY: Ensures effective pre-planning of treatments, allowing medical practitioners to demarcate areas of anatomy, treatment zones and important landmarks with precision to obtain accurate and results. This improves safety and reduces risk of inadvertent injection into pre-marked high-risk zones.
2. CONSISTENCY: A guided and consistent approach, particularly when the marked-up sites are photographed.
3. ASSESSMENT: Thorough assessment of the face to check for underlying pre-existing asymmetries which important to highlight prior treating a patient to avoid dissatisfaction with final results.
4. RECORD-KEEPING: Thorough and comprehensive clinical documentation for future treatments, from a medico-legal perspective, for patient education and portfolio development.
5. CONSENT & COMMUNICATION: An incredibly valuable part of the consent process to be communicated effectively. By marking the areas we plan to treat, and showing this to the patient, we can ensure we are both in line with the desired outcome, improving patient understanding and their satisfaction in the treatment results.
6. EDUCATION: An excellent way to educate and train other medical professionals, with clearly demarcated zones for live patient demonstrations.
The fundamental importance of marking-up should not be underestimated in aesthetics. We encourage all practitioners, at all levels, to incorporate marking-up into their treatment planning to improve outcomes and ensure reproducibility.
Reference:
Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas J Dermatol. 2020 Aug;61(3):217-225. doi: 10.1111/ajd.13273. Epub 2020 Mar 22. PMID: 32201935; PMCID: PMC7497045.