Blood Aspiration Test for Cosmetic Fillers to Prevent Accidental Intravascular Injection in the Face

BACKGROUND Filler injection for cosmetic treatment of the aging face may be complicated by visual impairment, skin necrosis, or anaphylaxis because of accidental intravascular injection. Blood aspiration test (withdrawal of blood by the syringe plunger before injection) may decrease the risk of intravascular injection. OBJECTIVE To evaluate the reliability of the aspiration test. METHODS AND MATERIALS A red ink solution was withdrawn from a cup using a syringe containing 0.1 mL filler (17 different filler products); when there was no aspiration, retesting was performed with larger-gauge needles until aspiration was observed. In a white rabbit, aspiration was attempted after puncturing the ear vein and withdrawing the syringe plunger (5 different filler products). RESULTS The aspiration test with an ink solution in vitro was negative with 8 filler products (47%) and positive with 9 filler products (53%); for all products that had a negative aspiration test, the test became positive when a larger-gauge needle was used. All 5 products tested with the rabbit ear aspiration test were positive. CONCLUSION The aspiration test was reliable with 53% syringes and needles tested. Fillers that have a negative aspiration test may be applied when the needle gauge is adjusted.