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In Vitro Evaluation of Preinjection Aspiration for Hyaluronic Fillers as a Safety Checkpoint

Torbeck, Richard L. MD*; Schwarcz, Robert MD; Hazan, Ezra MD; Wang, Jordan V. MD, MBE, MBA; Farberg, Aaron S. MD*; Khorasani, Hooman MD*

doi: 10.1097/DSS.0000000000001767
Original Article

BACKGROUND Hyaluronic acid (HA) fillers have increased in popularity. Although complications are rare, knowledge regarding their prevention and management are crucial. The utility of preinjection aspiration has become controversial.

OBJECTIVE Our study investigated the utility of preinjection aspiration as a safety checkpoint for HA fillers through comparison of physiochemical and rheological properties in an in vitro model.

MATERIALS AND METHODS Whole blood was drawn from vacutainers using syringes containing 10 commonly used HA fillers. Each HA filler was examined with the plunger pulled back at volumes of 0.2 and 0.5 cc. The time required to visualize a flash was recorded. Data were compared using physiochemical and rheological properties, pullback volumes, and needle gauges.

RESULTS Using a multivariable regression model, HA concentration, elastic modulus (G′), viscous modulus (G″), and complex modulus (G*) had significant relationships with time to flash, whereas needle gauge and pullback volume did not. However, when comparing pullback volume using an appropriate paired analysis, 0.5 cc pullback volume had a significantly decreased mean time to flash than 0.2 cc.

CONCLUSION Preinjection aspiration may have utility as a safety checkpoint for HA fillers. Practitioners may have to adjust pullback volume and waiting time to visualize the flash based on physiochemical and rheological properties.

*Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York;

Private Practice, New York, New York;

Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania

Address correspondence and reprint requests to: Richard L. Torbeck, MD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, 234 E 85th Street, 5th Floor, New York, NY 10028, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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