Oldream® Lift Instructions for Medical Professionals

Cheek filler is a fantastic skill for injectors to master as this mid-face treatment can elevate a person’s entire look when done well.

Read this Oldream Cheek Filler Instruction for medical professionals so that injectors can properly inject HA dermal filler. The procedure can achieve a range of results, including sculpting the cheeks to restore volume, lifting the midface, and revolumizing the tear trough areas.

How to Attach Needle to Syring?

Oldream® Lift Cheek Filler is designed with an innovative glass pre-fillable syringe for hyaluronic acid administration.

STEP 1: Remove the tip cap
Hold the syringe and pull the tip cap off the syringe as shown in Figure A.

STEP 2: Insert needle
Hold the syringe body and firmly insert the needle hub (provided in the Singderm® Lift package) into the luer-lock end of the syringe.

STEP 3: Tighten the needle
Tighten the needle by turning it firmly clockwise (see Figure B) until it is seated in the proper position as shown In Figure C.
NOTE: Continue to tighten until the needle is seated in the proper position.

STEP 4: Remove the needle cap
Hold the syringe body in one hand and the needle cap in the other. Without twisting, pull in opposite directions to remove the Needle cap as shown in Figure D.

Health Care Professional Instructions

1. Oldream® Lift injectable gel is a crosslinked, robust, injectable gel formulation, applied using a 26G needle to volumize and contour the cheek for correction of mid-face volume deficits.
2. Prior to treatment, the patient’s medical history should be obtained. The patient should be fully apprised of the indications, contraindications, warnings, precautions, treatment responses, adverse reactions, and method of administration. Patients also should be advised that supplemental “touch-up” implantations may be required to achieve and maintain maximum correction.
3. The patient’s soft-tissue deficiencies should be characterized by etiology, distensibility, stress at the site, and depth of the lesion. Pre-treatment photographs are recommended.
4. Topical or injectable anesthesia may be used to manage pain during and after injections.
5. After washing the treatment area with soap and water, it should be prepped with alcohol or other antiseptics. Prior to injecting, depress the plunger rod until the product flows out of the needle.
6. If the needle is blocked, do not increase the plunger rod pressure. Instead, stop the injection and replace the needle.
7. After insertion of the needle, and just before injection, the plunger rod should be withdrawn slightly to aspirate and verify the needle is not intravascular.
8. After the first small amount of material has been injected into the patient, wait 3 seconds to allow the lidocaine to take effect. Then proceed with the rest of the injections.
9. The injection technique for Oldream® Lift with regard to the angle and orientation of the bevel, the depth (subcutaneous and/or submuscular/supraperiosteal) of injection, and the quantity administered may vary depending on the area being treated. Injection of Oldream® Lift too superficially (intradermally), or in large volumes over a small area, may result in visible and persistent lumps and/or discoloration.
10. Oldream® Lift can be injected by a number of different techniques that depend on the treating physician’s experience and preference, and patient characteristics. Tunneling, fanning, serial punctures, cross-hatching, and fanning techniques may be used with Oldream® Lift to achieve optimal results. Injections may be administered antegrade or retrograde. Inject Oldream® Lift while applying even pressure to the plunger rod and slowly moving the needle in the subcutaneous or submuscular/supraperiosteal plane.
11. Oldream® Lift should be distributed in small aliquots (small boluses of 0.1 mL to 0.2 mL) over a large area to reduce the risk of persistent lumpiness.
12. With submuscular/supraperiosteal injections, the number of times the needle passes through the muscle should be minimized to reduce bruising risk. It is imperative to stop injecting before the needle tip reaches the deep dermis. This is to prevent material from being placed too superficially into the skin.
13. Correct to 100% of the desired volume effect. Do not overcorrect. The degree and duration of correction depend on the character of the defect treated. They also depend on the tissue stress at the implant site, the depth of the implant in the tissue, and the injection technique. Markedly indurated defects may be difficult to correct.
14. If immediate blanching occurs, the injection should be stopped and the area massaged until it returns to normal color. Blanching may represent a vessel occlusion. If normal skin coloring does not return, do not continue with the injection. Treat in accordance with Society for Dermatologic Surgery guidelines, which include hyaluronidase injections.
15. The area of lost facial volume should be lifted at the end of the injection. When the injection is completed, the treated site may be gently massaged to mold the product to the contour of the surrounding tissue. This will assure you that it is evenly distributed and conforms to the surrounding tissues contour. If overcorrection occurs, massage the area between your fingers or against an underlying superficial bone to obtain optimal results.
16. With patients who have localized swelling, the degree of correction is sometimes difficult to judge at the time of treatment. In these cases, it is better to invite the patient back to the office for a touch-up treatment.
17. After the initial treatment, additional treatment may be necessary to achieve the desired correction level. The same procedure should be repeated until a satisfactory result is obtained. The need for additional treatment may vary from patient to patient. It is dependent upon a variety of factors such as mid-face volume deficit severity, skin elasticity, and dermal thickness at the treatment site.
18. Patients may experience treatment site responses, which typically resolve within 1 week. Ice may be applied for a brief period following treatment to minimize swelling and reduce pain.
19. The health care professional should instruct the patient to promptly report any evidence of problems associated with the use of Oldream® Lift.

Patient instructions

It is recommended that the following information be shared with patients:

• Within the first 24 hours, patients should avoid strenuous exercise and extensive sun or heat exposure. Exposure to any of the above may cause temporary redness, swelling, and/or itching at the treatment site.
• If the treated area is swollen, an ice pack may be applied for a short period.
• To report an adverse reaction, contact Oldream Product Support Department at: [email protected]

WARNINGS

The product must not be injected into blood vessels. Introduction of Oldream® Silk injectable gel into the vasculature may lead to embolization, occlusion of the vessels, ischemia, or infarction. Take extra care when injecting soft tissue fillers. For example, after insertion of the needle, and just before injection, the plunger rod can be withdrawn slightly to aspirate and verify the needle is not intravascular. This will enable you to administer the product slowly, and apply the least amount of pressure necessary. Rare, but serious, adverse events associated with the intravascular injection of soft-tissue fillers in the face have been reported and include temporary or permanent vision impairment, blindness, cerebral ischemia or cerebral hemorrhage leading to stroke, skin necrosis, and damage to underlying facial structures. Immediately stop the injection if a patient exhibits any of the following symptoms, including changes in vision, signs of stroke, blanching of the skin, or unusual pain during or shortly after the procedure. Patients should receive prompt medical attention and possibly evaluation by an appropriate health care professional or specialist should an intravascular injection occur.

Product use at specific sites in which an active inflammatory process (skin eruptions such as cysts, pimples, rashes, or hives) or infection is present should be deferred until the underlying process has been controlled.

· Injection site responses consist mainly of short-term inflammatory symptoms starting early after treatment and lasting ≤ 7 days.