A key mission here at IMCAS is to encourage our physician members to be aware of the various complications that could arise with injections and how to undo the damage if possible. That’s why we propose various courses, lectures, webinars and IMCAS Alert (our complications forum for physicians), all of which are dedicated to help physicians better manage adverse reactions from aesthetic treatments.

We reached out to Dr Patrick Treacy, a prominent expert on the topic of dermal necrosis and vascular complications, to ask him to share his work and experience with the IMCAS Community.

You are one of our go-to experts when it comes to the topic of complications with injectables. What prompted you to delve into this matter?

I felt the makers of dermal fillers were not facing up to their responsibilities, as we were seeing a lot of complications, initially inflammation and later vascular occlusions but nobody was really addressing these. I had been dealing with complications for many years and in 2006, Michael Jackson had been sent to me to remove some fillers from his face. I realized during an IMCAS lecture in 2008 that the experts really had very little personal experience and were just quoting out-of-date papers on the subject. Hence, at that conference I was a lone voice saying we needed to be using ten times the dose of hyaluronidase that was being quoted for reversal of vascular occlusion, 750iu-1000iu instead of 75iu-100iu.

A major source of problem seems to be that practitioners and patients underestimate, or are unaware of, the dangers that come with injections. How could we better address this? 

We will never be able to fully address it when patients are willing to go to beauticians without any anatomical experience. Some suggest accepting this situation and just training them up, while others say this is our territory and it is sacrosanct. The truth is the people who disagree are furthest away from them professionally and there are too many unregulated training schools willing to teach anyone. The problem is really governmental than medical, it is regional rather than continental. The European Parliament should make regulations regarding who should inject what, in whom and where. 

And what advice would you give to physicians who are just about to launch their careers in aesthetics?

• Find someone with experience to mentor you. 
• Use only the best products. 
• Get proper insurance
• Learn how to deal with complications
• Start with the easier procedures

Could you give us a brief summary about your research on botulinum toxin and its effects on the brain? What is it about? 

In 1872, Charles Darwin recognized these features as a specific expression of sadness and attributed them to the activity of so-called ‘grief muscles’ in the frown area. Negative emotions, such as anger, fear, and sadness are prevalent in depression and are associated with hyperactivity of the corrugator and procerus muscles in the glabellar region of the face. Darwin formulated a new theory called the ‘facial feedback hypothesis’, which implied a mutual interaction between emotions and facial muscle activity. Many therapists, including Sommer (2003) have shown that patients who have been treated in the frown area reported an increase in emotional wellbeing and reduced levels of fear and sadness beyond what would be expected from the cosmetic benefit alone. Hennenlotter (2009) went one stage further and showed that botulinum toxin treatment to the frown area stopped the activation of limbic brain regions normally seen during voluntary contraction of the corrugator and procerus muscles. More recently, two centres, the Psychiatric University Hospital of the University of Basel, Switzerland and the Medical School Hannover, Germany conducted a randomized, placebo-controlled, double-blind trial. The study concluded for the first time that a single botulinum treatment of the glabellar region could reduce the symptoms of major depression. This effect developed within few weeks and persisted until the end of the sixteen-week follow-up period. I went one stage further and showed this effect is reversed if one just injects the periorbital are alone. We don’t note the overall effect as we usually inject both areas at the same time. I call it the "Botox (R) paradox".

We only grazed the tip of the iceberg with this interview. The details of your adventurous life is now available in your memoir “The Needle and the Damage”. What would you like to say to our IMCAS readers about your book and where can we purchase it?

It is available from many sources but the cheapest way to purchase it is from Amazon.co.uk  and also from Austin McCauley publishers.