Rates of Positive Aspiration Prior to Facial Hyaluronic Acid Filler Injections: Outcomes of a Multicenter, Cross-Sectional Study.

Abstract

Background: Before administering hyaluronic acid (HA) fillers, aspiration can be performed as a safety measure to verify whether the needle tip is possibly located within a vascular structure. However, the efficacy and utility of aspiration have been questioned. A real-world evaluation would contribute to the literature and understanding of how this technique is used globally.

Objectives: Determine the incidence (%) of positive pre-treatment aspiration in a real-world setting.

Methods: An observational study with a cross-sectional design was conducted to evaluate the incidence of positive aspiration before facial HA injections. Investigators from fourteen aesthetic/dermatologic practices in nine different countries participated in the study. The active data collection period was twelve weeks. Data of all patients presenting to the participating clinics during the active data collection phase, and who underwent HA injections to any region of the face were included. The aspiration technique included slowly pulling back on the plunger of the syringe and holding it back for a minimum of five seconds, to allow proper time for flashback.

Results: Data from 5,106 aspirations performed in 1007 individual patients was collected. In total, there were 35 cases (0.69%) of positive aspiration. However, there were significant differences in the incidence reported by investigators (range: 0 to 6.72%).

Conclusions: The results of this study may be used in an assessment of the utility of pre-treatment aspiration as a safety measure before performing HA filler injections, and they contribute to the understanding of the effect of various factors on positive pre-injection aspiration under clinical conditions.