Use ultrasound to identify existing dermal fillers and then directly visualize your needle entering the space where you can inject dissolving agents
i have a nurse on the left and uh my pa on the right and the nurse on the left is going to identify that pocket of uh aha and we're using a cannula here keep in mind that actually i tried injecting this blindly with hyaluronidase and there was no difference in the pocket again i think sometimes these form a little cyst or a pseudocyst and there's a little wall around them and that's why i think that some people come to me and they say they've been injected four five six times and they still have this nodule or swelling related to their prior ha so you can see that we are actually within the pocket you you can see the needle right here i'm sorry the cannula right here and she's injecting as we speak and you see almost resolution of that nodule before our very eyes there's another one this doesn't need to be a two-person procedure right like you could you do this by yourself one hand one hand on each one on the probe one on the needle you can do it it's if you have an assistance it's probably a little easier but you can do it because you're holding it and you're trying not to move and you're looking up at the screen and so it it's possible but i learned from my radiology colleagues that uh when they they're doing stuff they're they're using um assistant too the there is a enhancement to get needle enhancement which makes the needle or the cannula even better visualized but in this case i i wasn't using that and you can still see it pretty well um so and keep in mind that uh these are a lot smaller than you're used to on as well this is a 27 it's 27 gauge so it's pretty small and it's definitely not used to seeing a 27 gauge needle on the ultrasound you know that's kind of a blind procedure for me so right and keep in mind that this was basically painless there was a little bit of lidocaine added
