Dermal Filler Adverse Event Management

Having the Conversations with Your Patient About a Dermal Filler Adverse Event.

Having Conversations with Your Patient About a Dermal Filler Adverse Event starts with informed consent.

What is a dermal filler adverse event? Commonly it is called Vascular Compromise or a Vascular Accident.

The best thing we can do as cosmetic medical providers is to prevent adverse events by understanding products, anatomy, and the aging process. After developing a comprehensive understanding of the aforementioned concepts then, if the unforeseen happens, we must be prepared to manage the potentially deadly and or catastrophic event.

Part of the preparation process with the patient is the act of informed consent. Informed consent should only be considered complete if the patient signed the consent on the IPAD. Aesthetic injectors must be comfortable having an actual conversation about the risks and benefits. The verbal exchange throughout the consultation process should include a discussion about the risks and benefits of the treatment. Not only is this your legal responsibility, but you will be improving your chance of patient compliance if an adverse event occurs by educating the patient on early warning signs. Adverse events sometimes will surface visually once the patient has gone home. A patient not counseled on what to look for in the aftercare will miss the event, which could delay the effective management of the complication. Whereas the patient who was advised on the signs and symptoms of an adverse event will be able to recognize the symptoms early and reach out to the office to seek treatment. When patients are not counseled on the adverse events, they can end up in the emergency room or at their primary care provider’s office. Many emergency rooms and primary care offices do not specialize in aesthetic injectable medicine; therefore, they will not be able to manage a complication adequately. Aesthetic providers should be able to discuss the treatment’s pros and cons, educate the patient on the signs of an adverse event, and deliver safe and beautiful results.

Talking about an adverse event such as a vascular occlusion must start before the occurrence. You must be honest. Let the patient know that their primary care and the emergency room can not manage this type of adverse event; you and only you can assist. You are the special ingredient in their well-being.

Be sure to discuss the following topics with your patient:

Counsel on bruises
Counsel on anticipated pain
Discuss what swelling will be like
Send follow-up emails with reminders of what to expect, along with post-care instructions.
Call the next day to follow up
Schedule a two-week follow up
Provide them with your after-hours emergency contact

Additional preventative measures

Assessment during treatment
Keep an eye on the skin color
Asking patients frequently if they are ok

Adverse event management starts well before the treatment even begins. As aesthetic providers, we must educate the patient on the risk versus benefits of the treatments they are seeking. Not every adverse event is evident in the office; therefore, it is critical to involve the patient in learning the signs and symptoms of an adverse event. If you are not talking about it, then you are putting your patients at risk. The patients must be informed on what to look for during the early days of healing. Surgeons tell their patients the signs and symptoms of infection, and GYNs educate them on infection and postpartum bleeding.

These are relative risks that come along with the procedure. We must inform the patients that there is a risk and what their symptoms will look like should an adverse event occur. If we do not educate the patients on what to look for, they may miss the early warning signs, leading to a more challenging management of the issue.

Informed consent is not merely the patient signing a piece of paper. The process of informed consent includes the conversation about risks versus benefits coupled. The provider’s job is to educate and inform the patients, and then the consent to take treatment falls on the patient. Transparent communication is critical in the process of informed consent.

Many aesthetic injectors need help with informed consent for one of two reasons. First, they need more confidence in managing adverse events. The second reason is they need to figure out how to effectively communicate this process with the patient without scaring them away from its treatment. I have developed a list of ways to help aesthetic injectors develop confidence in informed consent beyond the foundation of anatomical and pharmacologic comprehension.

Steps to effective communication with your patient

Rapport. Do not just treat any patient for the money. If you question whether or not treatment is a good idea, then it likely is not a good idea; therefore, trust your gut. As excited as we are to have patients in our chairs, we ultimately choose them as their caregivers. If you are suspicious of their behaviors, they will likely not be compliant in an adverse event situation nor happy with the result.
Explain. I teach all my patients as if they are a student. I take time to provide great detail in reviewing the treatment and the risks with the patient. This minimizes the shock and terror if they have an adverse event. Fear of the unknown is more anxiety-producing than fearing the known. It has been argued that fear of the unknown is actually a fundamental fear! Fear of the unknown is fear of the perceived absence of information at any level of consciousness or any point of intellectual processing
Show them that you are the expert but also be humble. No matter your mastery level, please know that medicine is still the “practice of medicine”: they call it this for a reason. We have guidelines but think of the 8 billion people in the world; I am confident that every genetic makeup of all 8 billion will not follow cookie-cutter suit to conform to the diagnosis. We need to conform to the individual, not to the treatment. This means not every adverse will respond the same or present the same. The patient’s fears and anxiety or stoic nature will all play into how the handling and management of the situation
Practice. You can demonstrate this to your patients by showcasing your awards, certificates, and resume online. (CLICK here to see my Curriculum Vitae). Ultimately, you need to become an expert, no matter your degree. When you are the one injecting, it all falls on you.
Empathy. This goes without saying; we can demonstrate empathy by being relatable. Share your fears or perhaps insecurities with the patient. If you are an injector that hasn’t been injected, this can be unsettling to the patient; however, even worse is an over-filled injector.
Collaboration. Collaboration is critical in aesthetic medicine; you must have partners in this industry for peace of mind. You will also want to demonstrate that you are not on your own little independent island and that you have a support network and others to call, others you have learned from.
Technology. Technology can add a tremendous amount of value to educating your audience. Pick one platform, and communicate with your patients/audience frequently. I created a prep email for my patients that helps keep them in control of their knowledge. I also have a post-treatment email for them, and this reiterates everything I said during the consultative process.
CONSENT. The consent is both verbal and written. This is a process you are legally bound to perform. Move beyond the signature on the iPad and discuss risk versus benefit with your patient. This process will further develop the relationship as it demonstrates that you can be trusted. Explain everything to your patients, including the risk of nodules, occlusion, stroke, blindness, an outbreak of herpes, lymphatic stalling due to Neurotoxin in the periorbital area, Tyndall, periorbital edema, granuloma, even the little migrated or misplaced filler, biofilm, all of these are in my consent form and are a part of my conversation. Then I verbally tell them about the reversal process, and this consent is embedded within the filler consent. I recently added an arbitration agreement as well to my consent. You must have complicity in the face of an adverse event. Otherwise, you can’t help. I tell my patients this is so specialized that their primary care provider and emergency room cannot help. A vascular occlusion is an Emergency, and you are in the Emergency Room. However, with educated patients and safe practitioners, vascular occlusion is more of a nuisance than life-threatening. The treatment of nodules is also the aesthetic injector’s responsibility. This may shock you, but there are physicians, Nurse Practitioners alike that do not know the difference between Botox and filler.

In reality, the conversation starts before any adverse event occurs. The act of consent is not just a legal obligation; the process is also a moral obligation to inform and protect our patients.

medstar

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MEET

Tara Delle Chiaie

MSN, FNP-BC, APRN, ABAAHP

Owner/Master Aesthetic Injector

My name is Tara and I am the owner of Delle Chiaie Cosmetic Medicine. I have been in medicine since 2002 as a Registered Nurse. In 2011 I graduated from the accelerated program at the University of New Hampshire (UNH) as an Advanced Practice Registered Nurse (APRN) and immediately became nationally recognized through the American Nurses Credentialing Center (ANCC) as a Board Certified Nurse Practitioner. I grew up in the beauty industry and found it was a great union to blend beauty with medicine. I have an astute sense of safety, while my experience guides my practice to produce beautiful and natural results. My goal is to continually fine-tune the art of bringing one’s inner beauty to the surface.

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