FILLER ADVERSE EVENTS

In the event of a possible occlusion, do the following

1. Assess visual acuity ONE eye at a time

   1. Can the patient read text / count the fingers held up in front of them?
      1. Providers have an eye chart in the rooms
   2. Check for light perception
      1. Shine a cell phone light into both eyes
         1. An unaffected pupil will constrict
         2. Compare with affected eye, which will dilate if there is an optic nerve injury
   3. If visual pain or change is noted, or changes consistent with ischemia on the upper face
      1. Apply warm compress immediately – patient holds in place while Rx drawn up
      2. For HA fillers initiate Hyaluronidase (e.g. Vitrase, Hylenex) as per protocol
         1. If visual loss, INJECT 750U just above and 750U just below the globe
         2. At other sites, dose as follows:
            1. Vermilion and / or upper cutaneous lip: 500U
            2. Vermilion and / or lower cutaneous lip: 500U
            3. Nose +/- cutaneous lip: 750U
            4. Upper and lower cutaneous lip or melolabial fold: 750U
            5. Glabella: 500U
      3. For Calcium Hydroxyapatite (Radiesse®), or Poly-L-lactic acid (Sculptra®)
         1. flush the site vigorously with saline, and coordinate trip to ER for evaluation

2. Massage the site for 5 minutes on followed by 5 minutes of a warm compress every 30 minutes (as tolerated, avoid burning the skin or pressing to point of blanching)

3. Digital ocular massage

   1. Apply direct pressure on the globe through closed eyelid for 5 seconds and then release
   2. Repeat in pulsatile fashion every 10 seconds for 3 minutes, 3 sets

4. Provider must immediately contact Clinical Director + update chart in near real-time

   1. At a minimum, provider (and/or Clinical Director) should contact patient
      1. BID x 3 days, QD x 4 days, unless patient reports a complete resolution

         1. (more frequently as clinically indicated)

                                                                     **ORDER SETS**
            
                                              **Unless medication interactions are noted**
            

5. Glaucoma eye drops (All three drops every 15 minutes until patient can get to Ophtho)

   1. Timolol maleate 0.5% (kept in office)
   2. Apraclonidine
   3. Bimatoprost

6. Systemic medications to consider

   1. Acetazolamide 500mg BID x 1 wk
   2. ASA 325mg daily x 1 wk
   3. Sildenafil regimen 100mg daily x 1 wk
   4. Esomeprazole 40mg daily

IPL ADVERSE EVENTS

In the event of a possible burn, do the following

1. Assess thermal injury to the skin

   1. Provider must procure photos of the affected area to determine the degree of burn
      1. Consider a histamine reaction vs actual burn/thermal injury
      2. Consider patient behavior s/p procedure – sun exposure, photosensitizing Rx
   2. If laser burn is suspected, proceed after grading
      1. 1st degree burn – likely well defined reddish marks the size of the laser hand piece, no blistering
         1. Reassure client and provider
         2. IF patient chooses to treat OTC, Aloe Vera cream is advisable
         3. IF patient would like Rx, hydrocortisone 2.5% ointment is advisable
      2. 2nd degree burn – with the presence of blistering
         1. The use of a topical emollient (Aquaphor or a Polysporin) topical TID x 5 days is advisable.
            1. This will reduce chances of infection while adding to granulation of new tissue
         2. IF you would like to prescribe a medication for patient use
            1. Mupirocin 2% ointment is advisable, coupled with hydrocortisone 2.5% ointment to provide relief of symptoms
      3. 3rd degree burn – with s/s tissue necrosis
         1. Pt needs evaluation in the ED

2. Long-term follow up

   1. Provider is to contact patient
      1. BID x 3 days, QD x 4 days, unless patient reports a complete resolution
   2. In-person re-evaluation after 6 weeks for PIH

      1. And possible prescription for hydroquinone per Portrait protocols

                                                                             **ORDER SETS**
         
                                                   **Unless medication interactions are noted**
         

3. Topical medications

   1. Hydrocortisone 2.5% ointment BID dosing x 10 days
   2. Mupirocin 2% ointment TID x 10 days
   3. Long-term consider hydroquinone application for PIH