How Dermatologists and Plastic Surgeons Will Approach Injectables as Offices Reopen During COVID-19 Pandemic

For skilled injectors, she doesn’t foresee an eyes-up approach presenting a barrier to getting beautiful results. However, some have questioned this piecemeal method: Could treating the upper face alone while temporarily ignoring the lower two-thirds lend a lopsided look? The physicians we spoke to don’t seem to think so. “An artist can unquestionably produce a more beautiful picture when the whole canvas is available,” says Lara Devgan, a board-certified plastic surgeon in New York City. “But that doesn’t mean there isn’t value in addressing the face one area at a time.”

Echoing her sentiment, Sunder points out that in everyday practice, “It’s very common to stagger treatments and address different areas [at different times] — upper face in one visit; chin and jaw during a separate appointment; midface, cheeks, tear troughs in a third — to achieve a globally unified look in the end.”

What’s more, experts say, certain issues, like sunken temples, are frequently corrected in isolation anyway and don’t necessarily need to be offset by other shots to create a harmonious effect. “I certainly think this is a reasonable approach,” says board-certified Bryn Mawr, Pennsylvania, board-certified facial plastic surgeon Jason Bloom — “especially if that’s the area that is most concerning to someone,” as this is typically where he likes to start building results.

Why a Filler Reboot Raises the Stakes

In many practices, fillers will simply take longer to reenter the rotation. Though it may seem like these gels can be placed with the same ease and efficiency as Botox, they typically take longer to inject, according to Ashley Gordon, a board-certified plastic surgeon in Austin, Texas — particularly in zones that demand meticulous sculpting, like the jawline and chin.

“We also have to think more about potential complications with fillers,” she notes. If an errant needle stick were to block a blood vessel, restoring circulation could require urgent and time-consuming care, additional appointments, or even a trip to the ER — unnerving in ordinary times, and unacceptable during a pandemic.

Doctors also worry about the fate of filler patients who may fall ill post-injection. Some cases of delayed inflammatory reactions — bumps and nodules — have been reported in those who contract viruses, like the flu, after getting filler. “This is definitely a possibility with COVID-19,” Sunder says. “The likelihood of it happening is very low, as it is with other viral illnesses,” she notes; however, “We’re amending our consent forms to include this theoretical risk.”

Providers who plan on rolling out injectables without restrictions are sparing no expense to safeguard themselves, their staffs, and their patients. Bloom just upgraded all of his treatment rooms with powerful medical-grade air purifiers that circulate the air in the room 15 times an hour, cleaning it with a high-tech fusion of UV light, HEPA filters, and negative ions. “When someone breathes, that air is totally circulated out within three to four minutes,” he says.

Subbio is also investing in equipment that can hopefully mitigate the risks associated with injecting the unmasked. “We’ve ordered a few machines that will create a suction field directly over the head of a patient getting facial injectables, thereby helping to clear the air of any potentially infectious particles,” he explains.

Doctors (along with staff) will be performing injectable treatments in full PPE — masks (N95 respirators if available), gloves, scrubs, gowns, and eye protection. In keeping with new guidance recently published in Facial Plastic Surgery & Aesthetic Medicine, they’ll also be minimizing small talk to reduce the risk of airborne transmission through speaking and keeping appointments brief.

“I’m going to be offering all injectables when I start back — toxins, fillers, Kybella — and erring on the side of extreme caution, focusing on low-risk, minimal-downtime procedures on healthy patients under age 60,” says Devgan. She and her team will be donning N95s and face shields or goggles. Her patients will have masks on when getting upper-face injections.

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