Risks that come from injecting
Discussion of this treatment concentrates on the substance. A large part of the risk has nothing to do with the substance and everything to do with the needle, the skin and the setting.
Every injection through skin carries the possibility of introducing organisms into tissue that is normally protected. A treatment involving many punctures across an area multiplies the opportunities. The defences are the same as anywhere in medicine: clean skin, aseptic technique, sterile single use equipment, an appropriate environment, and a practitioner who understands why each of those matters.
The risks that follow from the act of injecting, rather than from the material, include infection, bleeding and bruising, nerve irritation, and inadvertent placement of material into a blood vessel. None of these is specific to polynucleotides and all of them are affected far more by who is injecting and where than by what is in the syringe.
4.4.1The skin barrier and what a needle does to it
Skin is a barrier that keeps organisms out. It is also colonised by organisms as a matter of normal biology. A needle passing through it can carry surface organisms into the dermis, which is not colonised and does not tolerate them well.
A treatment consisting of many small injections across an area creates many opportunities for this to happen. That is not an argument against the treatment; the same is true of many procedures. It is an argument for the preparation being taken seriously, and it is why the aftercare instructions aimed at infection are the ones with the clearest rationale.
4.4.2What actually reduces the risk
- Skin preparation. Cleansing and an appropriate antiseptic, applied and allowed to work rather than wiped on.
- Aseptic technique. Hand hygiene, gloves, not touching the prepared area or the needle, and not recontaminating a prepared field.
- Sterile single use equipment. One needle, one patient, opened in front of you. Reuse of needles between patients would be a serious failure and is not something you should ever have to think about, but you are entitled to see equipment opened.
- An appropriate environment. A clean clinical space with hand washing facilities and a surface that can be decontaminated. Not a kitchen table, a hotel room or the back of a salon with no clinical provision.
- Sound product handling. Product stored as the manufacturer specifies, not decanted, not shared between patients, not opened in advance.
4.4.3The setting question, which the law in England does not currently answer
In England there is at present no general licensing regime requiring premises offering non surgical cosmetic injectables to be registered or inspected. The Health and Care Act 2022 contains a power to introduce one, and the regulation chapter covers its status. In the meantime, the environment in which a procedure of this kind is carried out is, for many providers, a matter of professional judgement rather than of inspection.
The practical consequence is that the setting is something you have to assess for yourself. That is an unsatisfactory position and it is the current one. The things worth noticing are whether the space is a clinical space, whether there is somewhere to wash hands, whether equipment is opened in front of you, and whether sharps are disposed of properly.
| Risk | Source | What reduces it |
|---|---|---|
| Infection | Organisms carried through the skin barrier | Skin preparation, aseptic technique, sterile single use equipment, appropriate environment |
| Bruising and bleeding | Vessels punctured by the needle | Technique, and disclosure of anticoagulant medication |
| Vascular occlusion | Material entering or compressing a vessel | Anatomical knowledge, technique, and an emergency protocol |
| Nerve irritation | Needle placement near a nerve | Technique and anatomical knowledge |
| Blood borne virus transmission | Reused or contaminated equipment | Single use sterile equipment, which is not optional |
| Product related reaction | The material itself | Appropriate product, appropriate patient selection, disclosure of history |
A framework written by this publication to organise a decision. It is not a measurement, it is not drawn from any study, and no figure in it should be quoted as a finding.
4.4.4Blood borne viruses
Any procedure involving needles carries a theoretical risk of transmission of blood borne viruses if equipment is reused or if contamination occurs. With single use sterile equipment and proper technique that risk is negligible, which is precisely why single use equipment is not optional.
This is one of the reasons that treatment in non clinical settings, by people without training in infection prevention, is a materially different proposition from treatment in a clinical setting by someone who has been trained in it. The difference is not fussiness.
4.4.5Inadvertent intravascular placement
The face has a dense and variable blood supply. Material injected into a vessel, or injected in sufficient volume to compress one, can interrupt blood supply to the tissue that vessel serves. This is vascular occlusion, it is the serious complication of facial injectables, and it is a consequence of anatomy and technique rather than of the material.
Knowledge of facial vascular anatomy, awareness of the danger zones, appropriate technique, and an emergency protocol are what reduce this risk. None of those come from the product. They come from the training of the person holding the needle, which is the argument for caring a great deal more about who treats you than about which brand they use.
4.4.6Nerve irritation and other mechanical effects
Needles near nerves can produce transient altered sensation, and this usually resolves. Persistent altered sensation after a cosmetic injection warrants assessment rather than reassurance. Bleeding and bruising are mechanical consequences of vessels being punctured and are covered in the recovery article.
4.4.7What to notice, without being difficult about it
You do not need to interrogate anyone. You need to notice a small number of things, and they are all visible.
- Is this a clinical space, with hand washing facilities?
- Were hands washed and gloves put on in front of you?
- Was the skin actually prepared, rather than given a token wipe?
- Was the equipment opened in front of you?
- Is there a sharps bin?
- Is the product taken from its packaging in front of you?
If several of those are absent, the question of whether polynucleotides work has become the second most important question in the room.
Questions
Does it matter where I have this done?
A great deal. Infection risk, technique and the availability of emergency management all depend on the setting and on the training of the person injecting. In England there is currently no general licensing regime for premises offering these procedures, so the assessment falls to you.
What should I see before treatment starts?
A clinical space with hand washing facilities, hands washed and gloves put on in front of you, the skin actually prepared rather than wiped, equipment opened in front of you, a sharps bin, and the product taken from its packaging where you can see it.
Is there a risk of catching something from a needle?
With single use sterile equipment and proper technique the risk is negligible, which is exactly why single use equipment is not optional. Reuse of needles between patients would be a serious failure, and you are entitled to see equipment opened.
What is vascular occlusion and is it caused by the product?
It is interruption of blood supply when injected material enters or compresses a vessel, and it is a consequence of facial anatomy and injection technique rather than of the particular material. Anatomical knowledge and an emergency protocol are what reduce it, and neither comes in the box.
Can I be treated at home or at a party?
It is legal in England for many providers and it is a materially worse proposition. Infection control, emergency provision and the ability to manage a complication are all compromised outside a clinical setting, and the social context works against considered consent.
- NHS, Cellulitis
- NHS, Plastic surgery
- Health and Care Act 2022, section 180, licensing of cosmetic procedures
- Care Quality Commission
- Joint Council for Cosmetic Practitioners
- NHS, Dermal fillers
Links to regulators, professional bodies, legislation and research indexes. They are cited because they are public and checkable, not as endorsement of this publication. No source listed here has any commercial relationship with us.
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