Episode 162 hosts Gillian Murray (Prescribing pharmacist, clinical researcher and pharmacist injector based in London, UK)

Gillian has over 16 years experience working within the National Health Service and is the directorate pharmacist. In this role she consults on pharmacy education strategies at a local as well as national level. She is a senior lecturer in clinical pharmacokinetics at Kings College University.

Passionate about using medicines safely, Gillian set up 'Medicine in Aesthetics' to support aesthetic practitioners. She is also the Secretary for Complication in Medical Aesthetics Collaborative (CMAC). Gillian has a particular interest in hypersensitivity reactions, filler gel chemistry, rheology and is currently undertaking post-graduate research in this field.

We explore:

• How we came across Gillian's work
• Her background as a pharmacist and what a prescribing pharmacist is
• The dynamic of being a pharmacist injector in the UK
• What hyaluronic acid is and what it looks like structurally
• What the difference between natural and filler hyaluronic acid is
• What crosslinking is and what BDDE is
• The circumstances where we need to dissolve HA
• What hyaluronidase is
• How hyalase differs from hylanex
• On label uses of hyaluronidase vs off label uses
• The history of using hyalonidase to dissolve fillers
• What the incidence of allergic reactions is when using hyaluronidase
• Whether we should do patch testing with hyaluronidase or not
• Protocols for using hyalase - both emergency and elective
• The concept of 'dissolving clinics' and patients requesting their fillers to be removed
• The use of ultrasound guided hyaluronidase injections - is it the gold standard?

00:00 Introduction 01:03 Meet Gillian Murray 04:55 Role of CMAC and Managing Complications 10:59 What Hyaluronidase Is and How It Works 18:27 When and Why We Use Filler Dissolving 26:25 History of Hyaluronidase in Medicine 33:29 Different Brands and Purity of Hyaluronidase 41:37 Emergency Protocols for Vascular Occlusion 48:53 Pain, Swelling and Patient Reactions Explained 52:09 Allergy Risk, Bee Stings and Skin Testing Debate 61:45 Does Hyaluronidase Affect Natural Tissue 68:49 Risks of Overusing Dissolving Treatments 76:38 Elective Dissolving and Patient Expectations 80:09 Why Good Injecting Reduces the Need to Dissolve 86:34 Common Complications Seen in Practice 90:43 Final Safety Lessons for Responsible Use

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