Handle with care. Handle with Care. The writing found on packages containing fragile objects comes to mind, rereading the indications that come from the experts gathered on the occasion of the SIDeMaST National Congress – Italian Society of Dermatology and Sexually Transmitted Diseasesheld in Rimini.
Because given the increase in the use of injectable treatments – from fillers to botulinum toxin – which today represent some of the most practiced cosmetological procedures in dermatology, it is always necessary to respect the indications in terms of appropriateness and safety. We must never forget that these are medical actions which, although rarely, can lead to complications that are best prevented and avoided.
A growing market
“Injection procedures are real medical acts and require diagnosis, in-depth knowledge of the anatomy and specific training. Patient safety depends on the correct indication of the treatment and the ability to prevent and manage any complications”
comments Nicola Zerbinati, Professor of Dermatology at the University of Insubria-Varese and member of the SIDeMaST board of directors.
On the other hand, numbers help to explain the reasons for this warning from specialists. In fact, statistics say that an extremely high number of procedures with injectables are performed every year. According to data from the International Society of Aesthetic Plastic Surgery (ISAPS), in Italy in 2024 injectable treatments – in particular botulinum toxin, fillers based on hyaluronic acid and calcium hydroxyapatite – will exceed 760 thousand procedures overall.
The comparison with 2023 highlights a very marked growth: botulinum toxin goes from 194,335 to 316,385 treatments (+62.8%), while hyaluronic acid-based fillers grow from 190,606 to 430,598 procedures (+125.9%), confirming itself as the most dynamic segment. Overall, in our country, procedures have almost doubled from 2023 to 2024.
What possible complications
Let’s be clear. We are talking about very rare events. But one certainty remains. Prevention is better than cure and above all knowledge is the best form of prevention when it comes to health. At that time, it emerges from the conference that the complications, in addition to being infrequent, are in most cases mild and transitory, as can happen with swelling or the appearance of bruising. The data in this sense refer in particular to botulinum toxin, for which numerous studies document a low incidence of adverse events.
As regards fillers, while maintaining a high safety standard, asymmetries, nodules, irregularities and migration of the filler may occur; vascular complications represent the most severe ones (such as compressions and, in the most serious cases, arterial occlusions), with an estimated incidence of between approximately 0.004% and 0.5%, confirming their rarity. These risks can also be further reduced through training, the doctor’s experience and the use of advanced techniques, such as ultrasound guidance.
When is an ultrasound needed?
In this sense, experts focus their attention on skin ultrasound which appears to be very useful not only for diagnosing any problems, but also for planning targeted interventions, such as managing filler accumulations or tissue alterations that can cause compressions and irregularities. One of the most promising innovations is represented by ultrasound-guided injections, which allow the treatment to be performed by directly observing the anatomical structures. An approach that improves precision allows you to avoid sensitive areas and can help reduce the risk of complications.
“Ultrasound is not only used to evaluate any problems after treatment, but can become a fundamental tool for preventing them. Ultrasound-guided injections represent one of the most relevant innovations in recent years to increase the safety of procedures. However, the use of these techniques requires specific skills, both in reading the images and in the practical application during the procedures themselves”
comments Stefania Guida, Associate Professor of Dermatology at the Vita-Salute San Raffaele University and member of the SIDeMaST Board.
