ASDS releases new recommendations for physicians performing injectable filler procedures

The American Society for Dermatologic Surgery (ASDS) multispecialty Soft-tissue Fillers Guideline Task Force has released its evidence-based recommendations for physicians performing injectable filler procedures. The guideline, published in the February 2021 issue of Dermatologic Surgery, specifically addresses the prevention and treatment of adverse events from injectable filler treatments.

Evidence-based clinical guidelines provide a critical resource for physicians, and ASDS strives to be recognized as the authoritative source on the science of surgical interventional treatments of skin aging and skin disease. We have gathered the best available evidence within the scientific literature to form the basis for best practices in patient care for soft-tissue filler injections."

Derek Jones, MD, Chair, ASDS Soft-Tissue Fillers Guideline Task Force

The multidisciplinary task force was assembled in 2018 and consisted of ASDS member physicians (eight board certified in dermatology, two in plastic and reconstructive surgery, one in ophthalmology), two patient representatives and a methodologist:

• Derek Jones, MD, Chair
• Murad Alam, MD, MBA
• Kimberly Butterwick, MD
• Jean Carruthers, MD (Oculoplastic Surgery)
• Sue Ellen Cox, MD
• Steve Dayan, MD (Facial Plastic Surgery)
• Lisa Donofrio, MD
• Rebecca Fitzgerald, MD
• Shannon Humphrey, MD, FRCPC
• Nowell Solish, MD
• Jackie Yee, MD (Plastic Surgery)
• M. Hassan Murad, MD, MPH, Methodologist
• Shari Weiss, Patient Representative
• Lisa O'Keefe, Patient Representative

Using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the task force identified six critical questions to focus the guidelines and inform the literature research. The questions gauged risk factors for vascular occlusion; treatments for blindness; treatment of vascular occlusion of the skin without blindness; risk factors for nodules and inflammatory events with hyaluronic acid fillers; treatments for nodules and inflammatory events; and risk factors for nodules and inflammatory events from non-hyaluronic acid fillers.

ASDS commissioned the Mayo Clinic Evidence-based Practice Center to conduct systematic reviews to extract the data and summarize the relevant evidence. The guideline specifies recommendations for the:

• Prevention of vascular occlusion, blindness, stroke.
• Treatment of filler related vascular occlusion with blindness.
• Treatment of vascular occlusion (skin) without blindness.
• Treatment of nodules and inflammatory events from hyaluronic acid fillers.
• Treatment of nodules caused from permanent and semi-permanent fillers.