1. VIEW FROM THE SIDE TO AVOID COMPLICATIONS WHEN INJECTING IN THE LIPS

“Be sure whether you're filling the lips or the rest of the face that you don't just look at the patient from the front. And make sure the patient looks at a 45- and 90-degree angle also. You don't want to end up with ‘duck lips'. Patients come in and complain about other people who look unnatural. If you overfill and change that sideview angle from the nose to the mouth, they will look unnatural and duck-like.”

—Heidi Waldorf, MD, FAAD

Watch now: http://dermtube.com/series/daily-coveragedenver- 2014/avoiding-complications-when-injecting-the-lips.

2. DON'T FILL WHEN BLEPHAROPLASTY IS NEEDED

“The second most common (non-surgical complications around the eyelid region) I would say is the overuse of fillers, thinking they're going to raise brows or get rid of all the hollowing or changes people don't like around their eyelid with use of fillers.”

— Richard Anderson, MD

Watch now: http://modernaesthetics.com/ tv.asp?f=management-of-the-periocular-area

3. MINIMIZE BRUISING WHEN INJECTING: CONSIDER CANNULAS

“Using traditional techniques of fillers often leads to bruising. Using this new, innovative blunt cannula technique, bruising really is a thing of the past. The blunt cannula technique in contrast to traditional fillers only makes an injection through the skin one time. The blunt cannula is then passed under the skin and is directed and guided in a very fine and sculpting manner to the areas that need to be filled.

“The advantage of this is that you can get to all the areas that you want to fill and use any filler that you'd like. You avoid traumatizing vessels, traumatizing nerves, and it minimizes and in most cases elimantes any bruising at all.”

—Kian Karimi, MD

Watch now: http://modernaesthetics.com/ tv.asp?f=dermasculpt-injectable-fillers-no-bruise-fillers

You can read more about the use of blunt cannulas for dermal fillers in the March/April edition of Modern Aesthetics® magazine available online at ModernAesthetics. com or get the app with bonus materials via the iTunes store.

4. KNOW YOUR ANATOMY, ESPECIALY WHEN INJECTING AROUND THE NOSE

“I think there are a lot of caveats before injecting fillers into the nose that have to be considered. Sometimes I think we may gloss over those a little bit.

“It's important to understand the anatomy of the nose and also to understand the properties of the fillers before you actually inject them.”

—Steven Dayan, MD, FACS

Watch now: http://modernaesthetics.com/tv.asp?f=usingfillers-in-the-nose.

5. PREVENT VASCULAR OCCLUSION THROUGH IMPROVED INJECTION TECHNIQUE

“We're hoping the cannulas maybe improve safety. Right now vascular occlusion is a very rare event, but it's a terrible event when it does happen. And now that we're putting fillers in a little bit more deeply, I think we're seeing a little bit more vascular occlusion. …

“Creases seem to form over underlying deep arterial vasculature, so the angular artery seems to be under the crease that forms at the nasolabial fold, the supratrochlear artery is under the elevens. And it sort of give us a way to predict where it is and isn't safe to place deep fillers. Placing superficially under those creases is fine, but if the arterial flow is situated deeply under those creases, that's probably not a good idea. We're hoping using cannulas will just sort of move those vessels out of the way rather than pierce them.”

—Rebecca Fitzgerald, MD

Watch now: http://dermtube.com/series/dermjournalclub/ cosmetic-fillers-science-and-technique-with-rebecca-fitzgerald- md/

6. EMPHASIZE NATURAL RESULTS AND PROPER PROPORTIONS

“You really want to look at somebody and think everything's in proportion; it looks good. With the lip, I think establishing the patient's anatomy, their own little tubercles, and injecting those specific tubercles, which are the projection points, rather than making the whole lip look full and like two hot dogs parallel to one other is very important.”

—Joel L. Cohen, MD, FAAD

Watch now: http://dermtube.com/video/cohen-3/

7. GET TRAINED TO INTEGRATE COSMETIC PROCEDURES

“It's just creating more full service for your patients and you also retain them in your practice if you do some cosmetic dermatology. So it is important to integrate cosmetic procedures. And the best way really, if you haven't learned it in your residency or in some type of fellowship is to do preceptorships or first actually to go to cadaver courses...or just find a preceptor.”

—Hayes B. Gladstone, MD, FAAD

Watch now: http://dermtube.com/video/fillers-and-cosmetic- procedures/.