I started my journey into Cosmedicine in 2014 and am grateful to have trained under some of the best Appearance Medicine doctors and nurse-trainers in the country. In the early days of training, the importance of anatomy, always thinking of where your needle is and where it’s going, and always watching the surrounding structures has been drilled into me.  

While attending my first conference in the industry in 2015, watching Dr Stefania Roberts on stage showing pictures of her clients with vascular occlusions, it put the fear of God in my “injecting heart.”  

Seeing photos of different presentations and the progression until resolution made me think twice about my chosen path. Back then, Dr Stefania did go on to say that she’d been injecting for 18 years, and that the longer you inject the higher the chance of experiencing vascular occlusion. Hey, I’m the “baby nurse” in the room compared to everyone else that was there. I told myself, I’ll be okay. It is inevitable, but I will be okay. 

Since then, I always took time during my consultations to discuss all the possible adverse reactions. Taking time to explain how dermal filler can end up in a blood vessel, which leads to compromising the circulation there, which leads to tissue breakdown, necrosis and possibly blindness. Even if I see my clients going wide-eyed like they might want to leave my room, it is something I always need to do. I then discuss how low the incidences are, tell them about signs and symptoms, and how I would look after them should the situation arise. We refer to this as a fully informed consent process. 

Some clients would say to the young-looking nurse in front of them, “I’ve had this treatment lots of times elsewhere, and I’ve never heard of this.” To which I respond – I’m sorry you had that experience, it is my duty to give you all the information you need. Always.  

Fast forward to 2022, when I joined the high performing team that is The Face Place. Attending the Hyalase Workshop that Dr Catherine Stone runs yearly was part of my induction. I went in there thinking it is going to be a refresher course; I have been doing this for 8 years.  

I was wrong.  

The theory and shared experience from Dr Cat and Advanced Senior Nurse Marjorie were far more comprehensive than what I was exposed to previously. The practical component was an adrenaline-pumping experience with an actor portraying a patient who suddenly presented the threat of blindness, and the smaller groups having to go through the recommended protocol. I can honestly say that was “next level” training, and the fear of God in my injecting heart was replaced with grace that I have the tools I need should the worst of the worse happen. 

Murphy’s law governs my life, and the week prior to Christmas 2023, the inevitable finally happened. 

Client profile: 

Beautiful woman in her 50s, positive-ageing archetype. She regularly has injectables and maintains the natural look. We planned to hydrate and balance the lips with minimal hyaluronic acid dermal filler, and then soften the fine lines on her neck. Lips treated with dermal filler, 0.3ml used on lips and perioral area. Very thin thread across the treatment zone. I move onto the fine lines on her neck. The client is comfortable, chatty, and I see the bruise forming above her top lip. I made her aware and I carry on treating the neck, checking on the lips while injecting. Time felt a lot slower. 

Then I see it. That mottled colour change. Is this livido? No, it’s just a bruise that is turning into a nasty one. I can offer her Healite and re-assess.  

Are my eyes playing with me? Am I being OTT? I eyeballed it in between serial punctures on the neck lines, while the client checks the progress on her neck. It shouldn’t be, it cannot be – it’s Christmas in less than 2 weeks. She has a lot of events. I did my checks. Then my gut turned. It is what I think it is. I am like a duck sitting on water, calm on the surface with legs madly kicking under the water. I need to stay calm, so my client stays calm.  

I explain to my client that I do not like how the discolouration on her upper lip is developing, and that I’ll have one of my colleagues check too for a second opinion. I then asked my admin team to alert any nurse colleague who is available to visit my treatment room. 

While exchanging pleasantries with the client, I repeated the checks while my two nurse colleagues looked on. We exchanged glances. The look that conveyed the silent confirmation of a vascular occlusion. 

Beautiful Marjorie and Marilou took on roles in the room to support me like clockwork without having to ask. In the space of two and a half hours, my client  received two treatments of hyaluronidase with a Healite treatment in between. This dissolved the dermal filler and reversed all the signs of vascular compromise. 

A vascular occlusion happens in possibly one out of 100,000 clients having dermal filler treatment. I am grateful for the further training I received when I was being inducted into The Face Place. I am grateful for my client who listened during the consultation, and when the vascular occlusion happened she was patient and cooperative throughout the process. I am grateful too for the team of beautiful humans at The Face Place. I am grateful to be part of a team that has a justified reputation for being the best. Happy Days.