Category Archives: Belotero

What to do in case of Dermal Filler Emergency

In case of Dermal Filler Complication of Vascular Occlusion


This “essay” shows depth of knowledge. Proud of Surgical Artistry Team member, Karla, for her answer to this question when a student nurse from San Jose called asking for advice on a school project, “What should one do and have available in the event of a dermal filler emergency where vessels get occluded.” This is her expert response:

I am the Patient Care Coordinator for Surgical Artistry, Dr. Tammy Wu and Dr. Calvin Lee‘s office in Modesto, CA. You contacted our office regarding information for a nursing program project. I wanted to take this opportunity to answer any other questions you may have regarding the “mini-crash cart for injectables” for your project. I am very sorry for the delay in response and I hope this information is still helpful. We would include the following: a butterfly needle, a towel for warm compresses, nitro paste to dilate the vessels, and Hylenex to dissolve the filler. I can provide you with a little bit of background information.

Juvederm, Restylane, Perlane, Belotero, Prevelle Silk are HA fillers

juvederm boxBelotero Box

We use hyaluronic acid fillers, commonly referred to as HA fillers. The brand names of the fillers we use are Juvederm and Belotero. One of the benefits an HA filler is that they are dissolvable. There are two main products used for this purpose. They are Hylenex (hyaluronidase human injection) and Vitrase (hyaluronidase Ovine). Vitrase has an animal source; Hylenex has a bacterial source and is synthetic. Therefore, Vitrase sometimes requires a skin test/allergy testing. This would not be ideal in an emergency situation.

belotoro balance shelf

Emergency Kit: Butterfly needle with tubing, Hylenex 150 units, and Nitropaste

220px-Butterfly_needle hylenex(image)

If you had a vascular occlusion complication while injecting filler, you would use a butterfly needle to attempt to get into the occluded vessel by aspirating for a “flash”. If you get the “flash” then you are within the vessel and Dr. Lee would inject Hylenex – perhaps even up to 150 units of Hylenex. Even without a “flash”, Dr. Lee would still consider injecting the Hylenex. Then Dr. Lee might apply 2% nitropaste (for vasodilation) or a warm compress to this area with some massaging of the area to keep the blood flowing through the area.  The patient would then apply nitropaste at home 2-3 times per day if patients didn’t get severe headaches or light headedness from the nitropaste.

He would do the same even if a HA filler wasn’t used – such as Radiesse. He thinks that the Hylenex would dissove some of the body’s native HA and thus make more room for the vessel and hopefully un-occlude the obstruction.

Dr. Lee asked me to tell you that this is an excellent project idea, especially if you are an aspiring nurse injector. He says that filler emergencies are rare but it’s good to be prepared. Please do not hesitate to call me at (209) 551-1888. Also feel free to read Dr. Lee’s Botox blog.

Feel free to visit our main Modesto Botox home page.

Belotero and Botox for around the eyes.

Some initial thoughts of mine on Belotero.  These will change from time to time.  Much of this is consider off-label-FDA usage.

Belotero Balance and Botox for CROWS FEET

Off label FDA usage of Botox around the eyes has been the mainstay of treatment.  In my Modesto, CA practice, I’ve recently tried Belotero Balance – a dermal filler, to fill in the medium-fine lines that make up some of the crows feet.  Belotero seems to integrate nicely into the skin.  In conclusion, I think Belotero is a nice add-on in addition to Botox treatments around the eyes.  Belotero is most outstanding in those static line crows feet.


Under the eye area – I’ve been super pleased with Belotero Balance, as have our Modesto patients.  I have in the past used Restylane and Juvederm ultra in these areas  under the eye.  But I feel I get even smoother appearances under the eye with Belotero.

Belotero Balance for SCARS

This is where Belotero doesn’t seem to do as well.  Scars around the eyes and other areas on the face – I feel that even with freeing up some of the tissue under the scar, the Belotero isn’t able to lift the scars up as much as I’d like it to.  I think in these areas I may prefer a thicker dermal filler product.


Please feel free to visit my personally made Modesto Botox web page.