Injection Danger Zones— Irvine Dermatologist Nissan Pilest Participates in Cadaver Workshops Identifying “Don’t Touch” Structures

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Cosmetic injectables are becoming widely used in many areas of the face which are "off label". What are the danger zones; how will a filler behave in an untested location. Thirty three year Dermatology veteran Nissan Pilest participates in a special hands-on cadaver dissection workshop developed by some of the top dermatology and surgical researchers across the country.

Hands-on experience exploring the complex 3-dimensional anatomic structures of the face and neck

Cadaver Dissection Workshop by Docent LLC

“As a physician, this was an enormously educational opportunity. But, the real beneficiaries of these activities are the patients who place their trust in the physician who wields the needle.

Human Cadaver Facial Dissection Workshop - the title could only appeal to those in the medical profession. What purpose could such a workshop have?

Increasing uses of injectables for cosmetic advantages – both dermal fillers and neurotoxins – translate to increasing potential for mishaps. Properly and safely injecting filler materials or muscle-paralyzing toxins takes skill and knowledge of the anatomical tissue components beneath.

Although physicians in plastic surgery and dermatology have the most specific training with facial skin and underlying structures, exact behavior of injectable materials and how they integrate with and around those structural components has increased the need for a more complete understanding of exactly where these new placements would be the safest and the most effective in producing the desired effect.

The danger zone nerves and critical arteries present potential unacceptable outcomes for patients if these fragile structures are damaged. Avoiding these areas while delivering desirable cosmetic outcomes is a marriage of skill, knowledge and conservative decisions...and an intimate knowledge of skin and muscle anatomy, such as this workshop provides.

Dr. Pilest noted, after completing the workshop, “As a physician, this was an enormously educational opportunity. But, the real beneficiaries of these activities are the patients who place their trust in the physician who wields the needle.

"It is nothing more than our duty as doctors to seek as much precision training as exists to make sure our patients’ safety remains paramount. This workshop has exceeded my anticipation and I am grateful to my respected peers who made this possible. I wish it were mandatory for every injector in the country.”

As an injection trainer, Dr. Pilest sees emerging techniques with existing and forthcoming dermal fillers which can not only fill lines and stop frowns, but actually recontour the shape of the face to achieve a more balanced and ultimately more vibrant appearance.

Sponsored by the Postgraduate Institute for Medicine and Docent, LLC, the workshop is described: ” New Paradigm in Surgical Anatomy Instruction….the first of its kind Human Cadaver Facial Dissection Workshop is a unique, full face surgical anatomy and injection course designed to improve the safety of botulinum neurotoxin and dermal filler injection procedures.

"Human Cadaver Facial Dissection Workshop incorporates both cadaver dissections and patient injection demonstrations to provide clinicians with comprehensive practical instruction on the complex anatomic structures of the face. Meticulous head dissections will be utilized to examine anatomic planes, fascia, muscles, nerves, arteries and veins.

"Human Cadaver Facial Dissection Workshop will allow viewers to actually see and understand the relationships among anatomic structures that are quite small, inaccessible, often poorly taught and frequently misunderstood. Armed with this practical knowledge, clinicians will be in a better position to avoid anatomic neurovascular danger zones during botulinum neurotoxin and dermal filler injections.”

The workshop was two-part. A presentation to the attendees as a group was first; then small 4-5 physician groups were assigned to a specific instructor for precise close up view and interaction.

Injection demonstrations on cadavers allowed attending physicians to see “into” the skin and where and how injectables might compromise delicate arteries or nerves; as well as how to prevent compromise and steps to take when it’s recognized a problem occurred.

Follow-up live patient injections then reinforced the open-cadaver injection techniques, demonstrating needle angles, palpable “danger zone” nerves and arteries and how to achieve the best results for correctable patient concerns.

As a professional speaker and injection trainer himself, Dr. Pilest applauded the Institute for developing such a critically valuable program. “Every single aspect of this type of education deserves the serious attention of all doctors and other providers who deliver dermal fillers and toxins. “

Dr. Pilest speaks and trains for Allergan, Medicis and Merz for dermal fillers and the neurotoxins Botox, Dysport and Xeomin and is a laser training physician for Solta’s Fraxel CO2 laser and Candela Lasers.

Medical director of Tot al Dermatology in Irvine, California, Dr. Pilest is also an Associate Dermatology Professor at UCI and has practiced as a Board Certified Dermatologist since 1979. He is the 2011 Vice President of the Dermatological Society of Orange County. (949) 727 3800


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Jennifer Park

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