Cormac Convery - Academia.edu (original) (raw)
Papers by Cormac Convery
The Journal of clinical and aesthetic dermatology, 2021
The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization establis... more The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization established to promote best patient outcomes through educating clinicians in the prevention, diagnosis, and management of complications that can arise following nonsurgical cosmetic procedures. The organization is a global community sharing information, learning, experience, and data to promote best practices. This article explores how dermal filler vascular events can cause tissue ischaemia leading to a facial wound. Ideally, vascular events will be diagnosed early and amenable to reversal with hyaluronidase if caused by a cross-linked hyaluronic acid. If there is significant and extensive hypoxia to the area, there is delayed diagnosis, or the injected product cannot be reversed, the management should center around optimizing wound care. Both simple and complex wounds will benefit from good care. Patients seek aesthetic treatments to improve how they look and can be vulnerable to poor outcomes...
The Journal of clinical and aesthetic dermatology, 2021
The Complications in Medical Aesthetics Collaborative (CMAC) is a not-for-profit organization est... more The Complications in Medical Aesthetics Collaborative (CMAC) is a not-for-profit organization established to promote best patient outcomes through educating clinicians who perform nonsurgical cosmetic procedures in the prevention, diagnosis, and management of complications that can arise. The organization is a global community sharing information, learning, experience, and data to promote best practice. Herpes simplex is common in the general population. The risk of reactivation due to trauma is acknowledged in the literature. Reactivation of herpes simplex 1 following cosmetic procedures is considered rare, but there are no reliable data on the incidence. Although self-limiting, symptoms can be painful and distressing for patients who have undergone a procedure to improve their appearance. Clinicians should document the steps they've taken to avoid reactivation, and should be confident in their management plan and patient care if a patient suffers a reactivation. The authors ha...
The Journal of clinical and aesthetic dermatology, 2021
Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for ... more Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for the patient. Hyaluronidase is an enzyme that was first used in general medicine in 1949, but has gained widespread use in aesthetic medicine to dissolve hyaluronic acid (HA)-based dermal fillers. Knowledge of this drug and its use for other aesthetic indications is evolving, and there is often anxiety attached to the administration of animal-derived product due to fears of an allergic reaction. This paper provides guidance on the indications for use when dissolving HA filler with hyaluronidase. It discusses formulation differences, adverse events, allergy to wasp and bee stings, and how this increases risk of allergy to hyaluronidase. It also discusses incidence of allergy, which includes a discussion of types of allergic response and how this correlates to skin tests and a discussion on skin testing for allergy.
The Journal of clinical and aesthetic dermatology, 2021
There are multiple treatment strategies proposed for the management of vision loss related to the... more There are multiple treatment strategies proposed for the management of vision loss related to the injection of soft tissue fillers. Currently, there is no internationally accepted consensus on the immediate management of soft tissue filler induced vision loss (STFIVL). A recent systematic review of the literature concluded that there is not enough evidence to support retrobulbar hyaluronidase, and alternative treatments require exploration. The available literature demonstrates the inconsistent and unproven success of retrobulbar and peribulbar hyaluronidase in reversal of soft filler induced vision loss. Various therapeutics have been used to aid the reversal of vision loss but with mixed outcomes. The current evidence base does not support the use of retrobulbar and peribulbar hyaluronidase. The use of retrobulbar hyaluronidase for reversing soft tissue filler induced vision loss is controversial. Its efficacy remains unproven and there is mixed evidence within the literature. The...
The Journal of clinical and aesthetic dermatology, 2021
The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization establis... more The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization established to promote best patient outcomes through educating clinicians in the prevention, diagnosis, and management of complications that can arise following nonsurgical cosmetic procedures. The organization is a global community sharing information, learning, experience, and data to promote best practices. There is no reliable data on the risk or incidence of acute infection following a nonsurgical cosmetic procedure, but it is considered to be a rare complication. This article explores the evidence base for precautions and best practice standards, including an examination of the rational for standard aftercare advice and guidance on prevention, diagnosis, and management protocols.
˜The œJournal of clinical and aesthetic dermatology, May 1, 2021
Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for t... more Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for the patient. The occurrence, and subsequent management, of these negative outcomes is a source of significant stress to the aesthetic clinician. Complications management is an essential component of clinical practice and professionals must develop competence and confidence in the identification and effective treatment of a vascular occlusion. The relatively rare occurrence of a vascular occlusion mandates that learning must be largely through the study of theory in addition to the sharing of learning experiences within a collaborative clinical community. The delivery of optimal care begins with an understanding of the underlying pathophysiology and the ability to assess and elicit clinical signs. Establishing a clinical diagnosis, targeted therapy can commence in a timely fashion. This paper provides guidance on how to identify and manage a vascular occlusion caused by cross-linked hyalur...
˜The œJournal of clinical and aesthetic dermatology, Jun 1, 2018
The Journal of clinical and aesthetic dermatology, 2018
W elcome to the JCAD Aesthetic Complications Guidelines by The Aesthetic Complications Expert (AC... more W elcome to the JCAD Aesthetic Complications Guidelines by The Aesthetic Complications Expert (ACE) Group. The ACE Group developed a series of evidencebased, peer-reviewed guidelines that cover complications that can occur in nonsurgical aesthetic practices. The objective of this series is to help dermatologists and other physicians performing aesthetic procedures identify and manage these potential complications. Each guideline was produced after a vast literature review by leading experts in the United Kingdom. We hope these guidelines help raise treatment standards within the medical community and ensure early diagnosis and appropriate management of complications, ultimately improving outcomes for our patients.
The Journal of clinical and aesthetic dermatology, 2020
The three proposed mechanisms of vascular occlusion associated with cosmetic injection are:3 1. I... more The three proposed mechanisms of vascular occlusion associated with cosmetic injection are:3 1. Intravascular embolism 2. Extravascular compression 3. Vascular spasm. A study by Chang et al4 failed to show that vascular compression was reproducible in an animal model, although a case report by Lima et al5 showed that tissue hypoperfusion occurred following vascular compression identified using high frequency ultrasound. Vascular occlusion is possible via several mechanisms following cosmetic injections; however, intravascular embolism is the pathophysiology best supported by the evidence.3 When a blood vessel is inadvertently injected with filler material, the normal circulation can become impaired, leading to reduced tissue perfusion and compromise of the tissue relating to its angiosome.6 Most soft tissue fillers used in cosmetic practice consist of hyaluronic acid, and although hyaluronic acid is well-tolerated outside the vessel wall, it is highly inflammatory within blood vesse...
The Journal of clinical and aesthetic dermatology, 2021
Delayed-onset nodules (DONs) represent a poorly understood and generally neglected group of compl... more Delayed-onset nodules (DONs) represent a poorly understood and generally neglected group of complications. It is not a diagnosis. The underlying pathologies and their incidences are largely unknown due to the lack of specificity in clinical signs and the challenges in accessing diagnostic tests, cost implications, or reluctance from patients to undergo them. A lack of presumptive clinical diagnosis, coupled with management ranging from "scatter-gun" polypharmacy to clinical inertia, is believed to result in chronicity and increased morbidity. This paper provides guidance on the identification and understanding of the underlying pathologies and encourages the increased utilization of a medical model of care. The more routine adoption of histopathology, inflammatory markers, and ultrasound will permit a more targeted management and a greater understanding of the incidences and evolution of the pathologies.
The Journal of clinical and aesthetic dermatology, 2021
Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for t... more Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for the patient. The occurrence, and subsequent management, of these negative outcomes is a source of significant stress to the aesthetic clinician. Complications management is an essential component of clinical practice and professionals must develop competence and confidence in the identification and effective treatment of a vascular occlusion. The relatively rare occurrence of a vascular occlusion mandates that learning must be largely through the study of theory in addition to the sharing of learning experiences within a collaborative clinical community. The delivery of optimal care begins with an understanding of the underlying pathophysiology and the ability to assess and elicit clinical signs. Establishing a clinical diagnosis, targeted therapy can commence in a timely fashion. This paper provides guidance on how to identify and manage a vascular occlusion caused by cross-linked hyalur...
Acne scar morphology is dependent on the severity, depth and extent of the inflammatory and heali... more Acne scar morphology is dependent on the severity, depth and extent of the inflammatory and healing process that follows the development of an inflammatory acne lesion. Small superficial lesions will transepidermally discharge, and complete healing will often follow. If dermal inflammation is severe, follicular necrosis and sloughing will produce a focal intradermal atrophic scar. The dermal inflammatory process leads to the destruction of the follicle and also damage to the perifollicular dermal collagen architecture. Re epithelialisation of these necrotic, sloughed follicles will lead to dilated epithelialised tract formation. These vertical, tunnel-like, post-follicular necrosis remnants form the ice-pick atrophic scar subtype that we are all familiar with occurs. The enzymatic activity and inflammatory mediators will destroy deeper structures, leading to atrophic boxcar and rolling scar formation. As these scars mature, there is wound contraction that leads to further indentation.
Journal of Aesthetic Nursing
Ultrasound technology is finally being used outside of the hospital setting. The simple, non-inva... more Ultrasound technology is finally being used outside of the hospital setting. The simple, non-invasive and radiation-free imaging modality is now a reality in the medical aesthetic clinic. Ultrasound has been recognised as a suitable investigation in aesthetic complications since 2008 and recommended in practice since 2013. Technological advances have enabled professionals to deliver imaging in any environment. In treatment planning, delivery and aftercare, patient outcomes can be optimised. Ultrasound imaging allows reliable dermal filler identification, vascular mapping, management of vascular compromise and nodules, real-time rheology and measurement in relation to treatment outcomes. The challenges that remain relate to underpinning availability and enthusiasm with education and support. At the time of writing, there are no such mechanisms or educational programmes.
Journal of Aesthetic Nursing
Biofilms have been linked to dermal filler complications. Gillian Murray and Dr Cormac Convery ex... more Biofilms have been linked to dermal filler complications. Gillian Murray and Dr Cormac Convery explain their role and what clinicians can do to identify biofilm, as well as how to manage and treat them
Aesthetic Surgery Journal
Background Hyaluronic acid (HA) dermal filler injection is believed to be a safe procedure. Howev... more Background Hyaluronic acid (HA) dermal filler injection is believed to be a safe procedure. However, with the increase in the number of performed procedures and indications, the number of product-related complications, especially delayed inflammatory reactions, has also increased. Delayed-type hypersensitivity (DTH) reaction is one of these delayed inflammatory reactions, which is preventable by performing a pretreatment skin test. Objectives To find the incidence of delayed inflammatory reactions and DTH reaction after HA injection and to determine whether a pretreatment skin test is worthwhile to be performed. Methods A systematic literature review of all the relevant prospective studies, retrospective studies, and case reports on delayed inflammatory reactions and DTH reaction after HA filler injection. Results The incidence of delayed inflammatory reactions calculated from the prospective studies was 1.1% per year, and that of possible DTH reaction was 0.06% per year. Most retro...
The Journal of clinical and aesthetic dermatology, 2021
The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization establis... more The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization established to promote best patient outcomes through educating clinicians in the prevention, diagnosis, and management of complications that can arise following nonsurgical cosmetic procedures. The organization is a global community sharing information, learning, experience, and data to promote best practices. This article explores how dermal filler vascular events can cause tissue ischaemia leading to a facial wound. Ideally, vascular events will be diagnosed early and amenable to reversal with hyaluronidase if caused by a cross-linked hyaluronic acid. If there is significant and extensive hypoxia to the area, there is delayed diagnosis, or the injected product cannot be reversed, the management should center around optimizing wound care. Both simple and complex wounds will benefit from good care. Patients seek aesthetic treatments to improve how they look and can be vulnerable to poor outcomes...
The Journal of clinical and aesthetic dermatology, 2021
The Complications in Medical Aesthetics Collaborative (CMAC) is a not-for-profit organization est... more The Complications in Medical Aesthetics Collaborative (CMAC) is a not-for-profit organization established to promote best patient outcomes through educating clinicians who perform nonsurgical cosmetic procedures in the prevention, diagnosis, and management of complications that can arise. The organization is a global community sharing information, learning, experience, and data to promote best practice. Herpes simplex is common in the general population. The risk of reactivation due to trauma is acknowledged in the literature. Reactivation of herpes simplex 1 following cosmetic procedures is considered rare, but there are no reliable data on the incidence. Although self-limiting, symptoms can be painful and distressing for patients who have undergone a procedure to improve their appearance. Clinicians should document the steps they've taken to avoid reactivation, and should be confident in their management plan and patient care if a patient suffers a reactivation. The authors ha...
The Journal of clinical and aesthetic dermatology, 2021
Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for ... more Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for the patient. Hyaluronidase is an enzyme that was first used in general medicine in 1949, but has gained widespread use in aesthetic medicine to dissolve hyaluronic acid (HA)-based dermal fillers. Knowledge of this drug and its use for other aesthetic indications is evolving, and there is often anxiety attached to the administration of animal-derived product due to fears of an allergic reaction. This paper provides guidance on the indications for use when dissolving HA filler with hyaluronidase. It discusses formulation differences, adverse events, allergy to wasp and bee stings, and how this increases risk of allergy to hyaluronidase. It also discusses incidence of allergy, which includes a discussion of types of allergic response and how this correlates to skin tests and a discussion on skin testing for allergy.
The Journal of clinical and aesthetic dermatology, 2021
There are multiple treatment strategies proposed for the management of vision loss related to the... more There are multiple treatment strategies proposed for the management of vision loss related to the injection of soft tissue fillers. Currently, there is no internationally accepted consensus on the immediate management of soft tissue filler induced vision loss (STFIVL). A recent systematic review of the literature concluded that there is not enough evidence to support retrobulbar hyaluronidase, and alternative treatments require exploration. The available literature demonstrates the inconsistent and unproven success of retrobulbar and peribulbar hyaluronidase in reversal of soft filler induced vision loss. Various therapeutics have been used to aid the reversal of vision loss but with mixed outcomes. The current evidence base does not support the use of retrobulbar and peribulbar hyaluronidase. The use of retrobulbar hyaluronidase for reversing soft tissue filler induced vision loss is controversial. Its efficacy remains unproven and there is mixed evidence within the literature. The...
The Journal of clinical and aesthetic dermatology, 2021
The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization establis... more The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization established to promote best patient outcomes through educating clinicians in the prevention, diagnosis, and management of complications that can arise following nonsurgical cosmetic procedures. The organization is a global community sharing information, learning, experience, and data to promote best practices. There is no reliable data on the risk or incidence of acute infection following a nonsurgical cosmetic procedure, but it is considered to be a rare complication. This article explores the evidence base for precautions and best practice standards, including an examination of the rational for standard aftercare advice and guidance on prevention, diagnosis, and management protocols.
˜The œJournal of clinical and aesthetic dermatology, May 1, 2021
Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for t... more Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for the patient. The occurrence, and subsequent management, of these negative outcomes is a source of significant stress to the aesthetic clinician. Complications management is an essential component of clinical practice and professionals must develop competence and confidence in the identification and effective treatment of a vascular occlusion. The relatively rare occurrence of a vascular occlusion mandates that learning must be largely through the study of theory in addition to the sharing of learning experiences within a collaborative clinical community. The delivery of optimal care begins with an understanding of the underlying pathophysiology and the ability to assess and elicit clinical signs. Establishing a clinical diagnosis, targeted therapy can commence in a timely fashion. This paper provides guidance on how to identify and manage a vascular occlusion caused by cross-linked hyalur...
˜The œJournal of clinical and aesthetic dermatology, Jun 1, 2018
The Journal of clinical and aesthetic dermatology, 2018
W elcome to the JCAD Aesthetic Complications Guidelines by The Aesthetic Complications Expert (AC... more W elcome to the JCAD Aesthetic Complications Guidelines by The Aesthetic Complications Expert (ACE) Group. The ACE Group developed a series of evidencebased, peer-reviewed guidelines that cover complications that can occur in nonsurgical aesthetic practices. The objective of this series is to help dermatologists and other physicians performing aesthetic procedures identify and manage these potential complications. Each guideline was produced after a vast literature review by leading experts in the United Kingdom. We hope these guidelines help raise treatment standards within the medical community and ensure early diagnosis and appropriate management of complications, ultimately improving outcomes for our patients.
The Journal of clinical and aesthetic dermatology, 2020
The three proposed mechanisms of vascular occlusion associated with cosmetic injection are:3 1. I... more The three proposed mechanisms of vascular occlusion associated with cosmetic injection are:3 1. Intravascular embolism 2. Extravascular compression 3. Vascular spasm. A study by Chang et al4 failed to show that vascular compression was reproducible in an animal model, although a case report by Lima et al5 showed that tissue hypoperfusion occurred following vascular compression identified using high frequency ultrasound. Vascular occlusion is possible via several mechanisms following cosmetic injections; however, intravascular embolism is the pathophysiology best supported by the evidence.3 When a blood vessel is inadvertently injected with filler material, the normal circulation can become impaired, leading to reduced tissue perfusion and compromise of the tissue relating to its angiosome.6 Most soft tissue fillers used in cosmetic practice consist of hyaluronic acid, and although hyaluronic acid is well-tolerated outside the vessel wall, it is highly inflammatory within blood vesse...
The Journal of clinical and aesthetic dermatology, 2021
Delayed-onset nodules (DONs) represent a poorly understood and generally neglected group of compl... more Delayed-onset nodules (DONs) represent a poorly understood and generally neglected group of complications. It is not a diagnosis. The underlying pathologies and their incidences are largely unknown due to the lack of specificity in clinical signs and the challenges in accessing diagnostic tests, cost implications, or reluctance from patients to undergo them. A lack of presumptive clinical diagnosis, coupled with management ranging from "scatter-gun" polypharmacy to clinical inertia, is believed to result in chronicity and increased morbidity. This paper provides guidance on the identification and understanding of the underlying pathologies and encourages the increased utilization of a medical model of care. The more routine adoption of histopathology, inflammatory markers, and ultrasound will permit a more targeted management and a greater understanding of the incidences and evolution of the pathologies.
The Journal of clinical and aesthetic dermatology, 2021
Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for t... more Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for the patient. The occurrence, and subsequent management, of these negative outcomes is a source of significant stress to the aesthetic clinician. Complications management is an essential component of clinical practice and professionals must develop competence and confidence in the identification and effective treatment of a vascular occlusion. The relatively rare occurrence of a vascular occlusion mandates that learning must be largely through the study of theory in addition to the sharing of learning experiences within a collaborative clinical community. The delivery of optimal care begins with an understanding of the underlying pathophysiology and the ability to assess and elicit clinical signs. Establishing a clinical diagnosis, targeted therapy can commence in a timely fashion. This paper provides guidance on how to identify and manage a vascular occlusion caused by cross-linked hyalur...
Acne scar morphology is dependent on the severity, depth and extent of the inflammatory and heali... more Acne scar morphology is dependent on the severity, depth and extent of the inflammatory and healing process that follows the development of an inflammatory acne lesion. Small superficial lesions will transepidermally discharge, and complete healing will often follow. If dermal inflammation is severe, follicular necrosis and sloughing will produce a focal intradermal atrophic scar. The dermal inflammatory process leads to the destruction of the follicle and also damage to the perifollicular dermal collagen architecture. Re epithelialisation of these necrotic, sloughed follicles will lead to dilated epithelialised tract formation. These vertical, tunnel-like, post-follicular necrosis remnants form the ice-pick atrophic scar subtype that we are all familiar with occurs. The enzymatic activity and inflammatory mediators will destroy deeper structures, leading to atrophic boxcar and rolling scar formation. As these scars mature, there is wound contraction that leads to further indentation.
Journal of Aesthetic Nursing
Ultrasound technology is finally being used outside of the hospital setting. The simple, non-inva... more Ultrasound technology is finally being used outside of the hospital setting. The simple, non-invasive and radiation-free imaging modality is now a reality in the medical aesthetic clinic. Ultrasound has been recognised as a suitable investigation in aesthetic complications since 2008 and recommended in practice since 2013. Technological advances have enabled professionals to deliver imaging in any environment. In treatment planning, delivery and aftercare, patient outcomes can be optimised. Ultrasound imaging allows reliable dermal filler identification, vascular mapping, management of vascular compromise and nodules, real-time rheology and measurement in relation to treatment outcomes. The challenges that remain relate to underpinning availability and enthusiasm with education and support. At the time of writing, there are no such mechanisms or educational programmes.
Journal of Aesthetic Nursing
Biofilms have been linked to dermal filler complications. Gillian Murray and Dr Cormac Convery ex... more Biofilms have been linked to dermal filler complications. Gillian Murray and Dr Cormac Convery explain their role and what clinicians can do to identify biofilm, as well as how to manage and treat them
Aesthetic Surgery Journal
Background Hyaluronic acid (HA) dermal filler injection is believed to be a safe procedure. Howev... more Background Hyaluronic acid (HA) dermal filler injection is believed to be a safe procedure. However, with the increase in the number of performed procedures and indications, the number of product-related complications, especially delayed inflammatory reactions, has also increased. Delayed-type hypersensitivity (DTH) reaction is one of these delayed inflammatory reactions, which is preventable by performing a pretreatment skin test. Objectives To find the incidence of delayed inflammatory reactions and DTH reaction after HA injection and to determine whether a pretreatment skin test is worthwhile to be performed. Methods A systematic literature review of all the relevant prospective studies, retrospective studies, and case reports on delayed inflammatory reactions and DTH reaction after HA filler injection. Results The incidence of delayed inflammatory reactions calculated from the prospective studies was 1.1% per year, and that of possible DTH reaction was 0.06% per year. Most retro...