Asymptomatic Stroke After Hyaluronic Acid Filler Injection: Case Report and Literature Review

Moore, Ryan; Mueller, Melissa; Hu, Allison C.; Evans, Gregory R. D.

doi:10.1093/asj/sjaa381

Cited by 18 publications

(7 citation statements)

References 36 publications

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“…9 Depending on the anatomical location and percentage of occlusion, sequelae can range from local tissue necrosis to blindness and even stroke. 10 Even with prompt management, vascular complications can be irreversible. Therefore, a thorough understanding of facial anatomy is imperative before the administration of filler.…”

Section: Discussionmentioning

confidence: 99%

Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

Kern

Kollipara²,

Hoss

et al. 2022

Dermatol Surg

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BACKGROUND In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations. OBJECTIVE Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes. MATERIALS AND METHODS A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison. RESULTS Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae. CONCLUSION Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

Kern

Kollipara²,

Hoss

et al. 2022

Dermatol Surg

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“…[ 17 ] Mental status changes and stroke may develop if the embolism travels more proximally in the carotideal system and occlude the vertebral arteries. [ 18 ] The consensus gathered in 2019 presented a guideline for the acute treatment of vision loss resulting from filler injections. [ 19 ] Accordingly, high-dose hyaluronidase (1500 ıu) should be administered at the medial supraorbital margin where the supratrochlear and supraorbital arteries are located.…”

Section: Discussionmentioning

confidence: 99%

Detection of the Safe Zone for Upper Eyelid Hyaluronic Acid Injections

Can

BetülGözel

2022

Indian Journal of Dermatology

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Background: Hyaluronic acid (HA) injections for upper eyelid volumisation are safe procedures with short downtime and low complication rates. Nevertheless, the upper eyelid is a high-risk area for vascular complications because of its rich vascular network. After injection, bruising, an indicator of vascular penetration, develops very often and prolongs the short downtime. Aims: To describe a pain-controlled withdrawal technique for minimizing vascular complications and to examine the effects of topical anaesthesia administered prior to injection on complications related to vascular penetration. Methods: HA was injected into the upper eyelids of 25 patients using the pain-controlled withdrawal technique without topical anaesthesia. The patients’ median age, complication rates, average amount of HA administered, and follow-up periods were evaluated. In addition, the patients were asked to evaluate their pain during injection using a numerical pain rating scale. Results: The patients’ mean age was 40.4 ± 7.3 years. Minimal eyelid edema developed in all patients but did not prevent any of the patients’ social activities. No bruising was detected in any of the patients, and no major vascular complications, such as blindness or cerebrovascular events, developed. The average amount of HA administered was 1.43 ± 0.45 cc. All patients evaluated their pain during injection as mild. Conclusions: With the pain-controlled withdrawal technique, none of the patients had minor or major complications due to vascular penetration. The procedure was well tolerated by the patients. The detection of the safe injection zone allowed the administration of more than the standard/accepted 01 cc HA (up to 0.3 cc) from one point.

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“…Cerebrovascular injuries may manifest with region-specific neurosymptomatology or present subclinically via incidental findings on radiological imaging [ 267 , 268 , 269 , 270 ]. The anterior and middle cerebral arteries and their territories, owing to their proximity to the ophthalmic artery, are the most commonly affected regions in FIVO; as such, patients with periocular complications should undergo immediate radiological screening for cerebral stroke.…”

Section: Pathophysiology Of Ha-mediated Vascular Occlusionmentioning

confidence: 99%

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

Soares

2022

Molecules

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Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.

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Asymptomatic Stroke After Hyaluronic Acid Filler Injection: Case Report and Literature Review

Cited by 18 publications

References 36 publications

Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

Detection of the Safe Zone for Upper Eyelid Hyaluronic Acid Injections

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

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