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Dr. Martin's Blog
The glabella has been recognized for years as an area of risk for filler, but now has become almost a “no-go” zone. Blood supply to this area is supplied from both sides, but the vessels are small and easily compressed or thrombosed. The supratrochlear and trochlear arteries are situated very close to the glabella. In addition, retrograde flow though the trochlear artery can cause blindness.The prevailing wisdom seems to be that the safest approach is by cannula if targeting SubQ or very superficially into the dermis.
Fillers | June 1, 2016
I had one of our past students call the other day and ask about Hyaluronidase. His problem was this: He had inadvertently administered some Juvederm ultraplus more superficially than intended. When the patient came back in 2 weeks, she had a superficial lump. He wanted to know how to fix it.
Hyaluronidase digests hyaluronic acid – both from temporary HA fillers and natural HA. As a result, be as specific as you can about where it is being injected. It comes in a vial of 150 IU/ml from any compounding pharmacy eg. Habers or York Downs in Toronto. I normally draw up between 0.3 and 1.0 ml into a 1cc syringe and inject it as directly as possible into the area of concern. In this case, 0.3 ml into the palpable filler will suffice.
Followup in another 2 weeks. It will take about that long for the hyaluronidase to take effect. If it is not yet flat, then inject another 0.3 ml.