Speaking as the patient in this particular case, Victoria and her medical director handled the whole thing perfectly. I felt like they went above and beyond to make sure I had ample treatment to 1) feel confident in my safety, and 2) be comfortable and supported in a painful and serious situation! I was also aware that this was Victoria’s first earlobe treatment, and aware of the degree of training she was able to get access to before moving forward. I trust her medical knowledge and critical thinking to the fullest extent. As she mentions, I’ve been injected many times (by several different injectors, and at this point Victoria and her medical director are the only injectors I feel confident being treated by in my area) and truthfully, I am almost grateful to have gone through a VO. I am more aware of what shouldn’t be ignored as a side effect, what treatment standards to expect should I ever experience a VO in the future, and I now concretely understand the reversibility of treatments with dermal filler. All in all Victoria is knowledgeable, caring, and supportive to her patients. I’m glad that our experience can be used for wider learning in a community of injectors who take an active interest in case studies. I think this is a testament to how medical expertise - and, in our area, regulations - are integral to getting high quality, well-rounded service from start, to finish, to future treatments. Thanks Victoria!
Hats off to Victoria for baring her soul to explain her thought process behind the treatment of this seldom injected area. Well done. Appreciate your honesty and integrity in solving this VO!!
Great video. As a medical professional, filler is not the end all, be all solution, especially with restoration of the earlobes. Most patients that have had guages in their ears for a number of years and want to rid this look.....this requires a surgical procedure. That being said, I thank her for sharing her story.
Excellent that this provider is willing to have an open discussion about this event. The positives are this nurses relationship with their patient, the follow up provided, the awareness of VO complications and the availability and use of hyaluronidase. This demonstrated a higher level of care than what is happening with many providers of aesthetic treatments. I commend this injectors willingness to share, to learn and to improve. This is just unfortunate to have happened. It is disappointing that there was not a more experienced medical director involved or a referral to a medical colleague. This could have resulted in a more thorough evaluation (otoscopy, HRUS, etc.) and a collaborative and less stressful patient management experience. There are some simpler techniques for improving stretched ear piercings using HA that should be safer and more effective than "multiple retrograde threads" as described.
Thank you Dr. Tim and Victoria for sharing this case so openly and honestly to help educate the rest of us. I love that you walked us through the whole process from the injection and consent to the occlusion and treatment. In my opinion it is so helpful to be open about these issues and share the information to help us all be better injectors. Dr. Tim I am especially grateful that you are so transparent about so many techniques and concerns in your practice and so willing to share and teach. Thank you!
Hi Tim, I hope you're well! It would be really interesting to know the order of injection depth Victoria followed. Do you know whether she went with her filler injection depth first? Or whether multiple depths were attempted at each round? Sitting here ponding hypothetical solutions, I wonder whether anyone has ever tried intravenous injection of dissolver into pertinent arteries to treat a V.O or is this a terrible idea?!
What can i say. Very impressing that she letting us be part of it. a very big thank you fom Germany to Canada . I think injecting hyalase into a vessel is useful when I know where the occlusion is. Preventively, I don't think it's of much use. I try to inject the hyalase in the best case with the same needle and the same pattern. This way there is a good chance to find the spot that is responsible for the occlusion.
Thanks for sharing. We know that there are probably end arteries in the ear lobe. For the same reason it’s in advisable to inject lidocaine with adrenaline into the ear lobe, perhaps one should inject fillers with extreme caution. I think it’s a high risk area for vascular occlusion. I suggest that one should always be prepared with hyaluronidase.
could be just a vascular compression due to much AH injected? beeing a plastic surgeon, i did surgeries on ear lobe and usually the vessels are very, very tinny, lot of capilaries, and if there is an amputation of the ear lobe, you can put it in place, with no vascular suture. and also, due to areolar structure of the lobe and the thining skin., i think the best aproach is to inject in the middle, not under the skin
I noticed that this patient has a small divet along the opening to the ear. Its my understanding that it is an indication of an underdeveloped ear channel, a channel that never developed as it was supposed to. Could this have contributed to the misapplication of the filler? The reason I remember this, was because it was not something that I ever knew about.
❤to Victoria. I probably would have made an incision with a 18g venesectio needle to release the capillary pressure after flushing the area with hyaleronidase. And fingers toes ears and penises. No go for me.
If this was a non medic saying that she watched you tube videos and had no training on the area she treated they'd be crucified for this but because she's a medic its ok everyone
Sure, medics can loose their licence if a patient starts a legal case. What would a non-medic loose? A non-medic should not touch a patient, because he can't be held responsible in a case of a problem.
Yes, exactly. That's what a university degree in a medical field actually validates: Your ability to weigh up information and make a decision at a complex level, and justify that decision with respect to your patients overall health. Non medics don't have that validation. That's why they are called ’non medics’.
Thanks for joining the conversation! Allow me to clarify - I’ve had extensive training in fillers and have seen earlobe filler done before - however, doing it myself, this was my first! I didn’t “learn” through RUclips videos, but outlined my process in preparing even before the patient came to the clinic, which included reviewing videos! As we discuss, this is an area with almost little to no thorough education for injectors as is generally considered low-risk. As a medical professional, I would never inject an area I wasn’t comfortable with either. Hope this helps!
The medic was qualified, educated to a high level and had in depth understanding and knowledge of the risks, the anatomy, medicine, patient care, what was occurring and how to correct it. They are therefore validated to carry out these procedures safely. They have studied for years and understand the importance of critical thinking from a medical perspective. The perspective that legally has a responsibility to protect the public and treat a MEDICAL emergency.
![Vascular Occlusion: How Many Vials Of Hyalase Do You REALLY Need? [Aesthetics Mastery Show]](http://i.ytimg.com/vi/N-n7Hj_4RVI/mqdefault.jpg)
![Vascular Occlusion: How Many Vials Of Hyalase Do You REALLY Need? [Aesthetics Mastery Show]](/img/tr.png)
Speaking as the patient in this particular case, Victoria and her medical director handled the whole thing perfectly. I felt like they went above and beyond to make sure I had ample treatment to 1) feel confident in my safety, and 2) be comfortable and supported in a painful and serious situation!
I was also aware that this was Victoria’s first earlobe treatment, and aware of the degree of training she was able to get access to before moving forward. I trust her medical knowledge and critical thinking to the fullest extent.
As she mentions, I’ve been injected many times (by several different injectors, and at this point Victoria and her medical director are the only injectors I feel confident being treated by in my area) and truthfully, I am almost grateful to have gone through a VO. I am more aware of what shouldn’t be ignored as a side effect, what treatment standards to expect should I ever experience a VO in the future, and I now concretely understand the reversibility of treatments with dermal filler.
All in all Victoria is knowledgeable, caring, and supportive to her patients. I’m glad that our experience can be used for wider learning in a community of injectors who take an active interest in case studies. I think this is a testament to how medical expertise - and, in our area, regulations - are integral to getting high quality, well-rounded service from start, to finish, to future treatments. Thanks Victoria!
Hats off to Victoria for baring her soul to explain her thought process behind the treatment of this seldom injected area. Well done. Appreciate your honesty and integrity in solving this VO!!
Great video. As a medical professional, filler is not the end all, be all solution, especially with restoration of the earlobes. Most patients that have had guages in their ears for a number of years and want to rid this look.....this requires a surgical procedure. That being said, I thank her for sharing her story.
Excellent that this provider is willing to have an open discussion about this event. The positives are this nurses relationship with their patient, the follow up provided, the awareness of VO complications and the availability and use of hyaluronidase. This demonstrated a higher level of care than what is happening with many providers of aesthetic treatments. I commend this injectors willingness to share, to learn and to improve. This is just unfortunate to have happened. It is disappointing that there was not a more experienced medical director involved or a referral to a medical colleague. This could have resulted in a more thorough evaluation (otoscopy, HRUS, etc.) and a collaborative and less stressful patient management experience. There are some simpler techniques for improving stretched ear piercings using HA that should be safer and more effective than "multiple retrograde threads" as described.
Wow! Thanks for being open and honest. This was excellent. Great critical care thinking and approach to treatment.
Thank you Dr. Tim and Victoria for sharing this case so openly and honestly to help educate the rest of us. I love that you walked us through the whole process from the injection and consent to the occlusion and treatment. In my opinion it is so helpful to be open about these issues and share the information to help us all be better injectors. Dr. Tim I am especially grateful that you are so transparent about so many techniques and concerns in your practice and so willing to share and teach. Thank you!
Thank you for sharing this case with the ear lobs, it make us aware to prevent any situation!.....
Thanks for tis interesting case! Not a daily complication but now I will never forget it and will be Abel to treat it ...hopefully!!
great educational video! thanks so much. did she gave some antibiotics after procedure?
Hi Tim, I hope you're well! It would be really interesting to know the order of injection depth Victoria followed. Do you know whether she went with her filler injection depth first? Or whether multiple depths were attempted at each round? Sitting here ponding hypothetical solutions, I wonder whether anyone has ever tried intravenous injection of dissolver into pertinent arteries to treat a V.O or is this a terrible idea?!
Thanks for all the emails and great info sharing
What can i say. Very impressing that she letting us be part of it. a very big thank you fom Germany to Canada . I think injecting hyalase into a vessel is useful when I know where the occlusion is. Preventively, I don't think it's of much use. I try to inject the hyalase in the best case with the same needle and the same pattern. This way there is a good chance to find the spot that is responsible for the occlusion.
Thanks for sharing. We know that there are probably end arteries in the ear lobe. For the same reason it’s in advisable to inject lidocaine with adrenaline into the ear lobe, perhaps one should inject fillers with extreme caution. I think it’s a high risk area for vascular occlusion. I suggest that one should always be prepared with hyaluronidase.
Did she aspirate before injection? Or she did and even though she had VO?
could be just a vascular compression due to much AH injected? beeing a plastic surgeon, i did surgeries on ear lobe and usually the vessels are very, very tinny, lot of capilaries, and if there is an amputation of the ear lobe, you can put it in place, with no vascular suture. and also, due to areolar structure of the lobe and the thining skin., i think the best aproach is to inject in the middle, not under the skin
Well done and thank you for sharing
Thank you for sharing
I noticed that this patient has a small divet along the opening to the ear. Its my understanding that it is an indication of an underdeveloped ear channel, a channel that never developed as it was supposed to. Could this have contributed to the misapplication of the filler? The reason I remember this, was because it was not something that I ever knew about.
❤to Victoria. I probably would have made an incision with a 18g venesectio needle to release the capillary pressure after flushing the area with hyaleronidase. And fingers toes ears and penises. No go for me.
If this was a non medic saying that she watched you tube videos and had no training on the area she treated they'd be crucified for this but because she's a medic its ok everyone
Sure, medics can loose their licence if a patient starts a legal case. What would a non-medic loose? A non-medic should not touch a patient, because he can't be held responsible in a case of a problem.
@@diastemma still not sensible whatsoever to watch videos on how to inject an earlobe without ever having done it before. This is so irresponsible
Yes, exactly. That's what a university degree in a medical field actually validates: Your ability to weigh up information and make a decision at a complex level, and justify that decision with respect to your patients overall health. Non medics don't have that validation. That's why they are called ’non medics’.
Thanks for joining the conversation! Allow me to clarify - I’ve had extensive training in fillers and have seen earlobe filler done before - however, doing it myself, this was my first! I didn’t “learn” through RUclips videos, but outlined my process in preparing even before the patient came to the clinic, which included reviewing videos! As we discuss, this is an area with almost little to no thorough education for injectors as is generally considered low-risk. As a medical professional, I would never inject an area I wasn’t comfortable with either. Hope this helps!
The medic was qualified, educated to a high level and had in depth understanding and knowledge of the risks, the anatomy, medicine, patient care, what was occurring and how to correct it. They are therefore validated to carry out these procedures safely. They have studied for years and understand the importance of critical thinking from a medical perspective. The perspective that legally has a responsibility to protect the public and treat a MEDICAL emergency.