Avoiding and Treating Blindness From Fillers

Beleznay, Katie; Carruthers, Jean; Humphrey, Shannon; Jones, Derek

doi:10.1097/dss.0000000000000486

Cited by 420 publications

(238 citation statements)

References 43 publications

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“…Plastic surgeons nowadays are working on improved injection techniques and rescue solutions once embolism occurred. [33][34][35] Our injected 3D MA-HA cryogel had a diameter of 5 mm, which is far larger than the diameter of subcutaneous blood vessels, thus minimizing the risk of inadvertent blood vessel embolization.…”

Section: 27mentioning

confidence: 99%

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Cheng

Shih

et al. 2017

Tissue Engineering Part A

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Introduction: Hyaluronic acid (HA)-based fillers are used for various cosmetic procedures. However, due to filler migration and degradation, reinjections of the fillers are often required. Methacrylated HA (MA-HA) can be made into injectable shape-memorizing fillers (three-dimensional [3D] MA-HA) aimed to address these issues. In this study, shape retention, firmness, and biocompatibility of 3D MA-HA injected subcutaneously in mice were evaluated. Materials and Methods: Fifteen mice, each receiving two subcutaneous injections in their back, were divided into four groups receiving HA, MA-HA, 3D MA-HA, or saline, respectively. Digital imaging, scanning electron microscope (SEM) and in vivo imaging system (IVIS), durometry, and histology were utilized to evaluate in vitro/ vivo degradation and migration, material firmness, and the angiogenic (CD31) and immunogenic (CD45) response of the host tissue toward the injected materials. Results: Digital imaging, SEM, and IVIS revealed that 3D MA-HA fillers maintained their predetermined shape for at least 30 days in vitro and in vivo. Little volume effects were noted in the saline and other control groups. There were no differences in skin firmness between the groups or over time. Histology showed intact skin architecture in all groups. Three-dimensional MA-HA maintained its macroporous structure with significant angiogenesis at the 3D MA-HA/skin interfaces and throughout the 3D MA-HA. There was no significant inflammatory response to any of the injected materials. Conclusion: 3D MA-HA showed remarkable tissue compatibility, compliance, and shape predictability, as well as retention, and thus might be suitable for various skin sculpting and soft tissue reconstruction purposes.

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Section: 27mentioning

confidence: 99%

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Cheng

Shih

et al. 2017

Tissue Engineering Part A

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“…Beleznay et al [23] found that the combination of larger volumes of filling material together with a deeper placement of the material increases the risk of vascular compromise. This aspect, coupled with use by physicians who are not experts in the use of these techniques and have an inadequate knowledge of facial anatomy, is leading to an increased risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

et al. 2019

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Objective: Dermal fillers are an important tool in the field of aesthetic dermatology. Fillers are relatively noninvasive and easy to use but are not free of secondary complications. The main complications are vascular and are due to either the compression of an artery or the direct introduction of the product into the arterial lumen. The aim of this study is to provide an overview of the vascular territories of the face to avoid many possible complications when using facial fillings. Anatomical localization of the main arterial supply to the face has been described to assess the risk of vascular injury. Methods: The authors dissected 17 hemifaces of embalmed adult cadavers that had previously been injected, through the common carotid artery, with latex containing a red dye. Results: A topographic distribution was generated by facial regions following a clinical approach from where the facial fillings were placed and related to the pathways of the arteries. Following these criteria, we established 8 topographic regions (I–VIII) that indicate the main vascular problems of each of these regions. Detailed anatomical localizations of the main arteries in these topographic regions of the face and their relationships are described. Conclusions: The highest index of vascular lesions and especially visual alterations occurred for fillings of the upper third of the face. To prevent and avoid this type of lesion, it is advisable to avoid, as much as possible, treatments with filling materials in the upper third of the face, mainly including the glabellar and nasal region (III) and supraorbital region (VIII).

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“…This pivotal role of the facial vein as a hallmark structure in the face is of great importance when trying to understand the detailed anatomy of the facial fat compartments and to avoid complications. Of those, irreversible blindness resulting from filler or autologous fat transfer procedures is considered the most dangerous one [19,27].…”

Section: Discussionmentioning

confidence: 99%

Facial Vein Variation: A Cadaveric Study

Arquez

2018

int arch med

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Background: The veins of the head and neck have a complex developmental pattern which predisposes them to variations in formation and drainage. Superficial veins of the head and neck are utilized for central venous cannulation, oral reconstruction and parenteral nutrition in debilitated patients. Clinical and sonological examinations of these veins may provide clues toward underlying cardiac pathology. Aims:The aim of the present study was to describe anatomical variation and determined the position of the facial vein in relation to neighboring structures. Methods and Findings:Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 16 males and 2 females, i.e. 36 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 34 sides (94.5%) of the cases the facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic description. The facial vein on two sides (5.5%) was found to drain into the external jugular vein with different degree of angulations and variable distance from the angle of the mandible. On the right side, the facial vein was draining into external jugular vein (EJV), 63.6 mm below the angle of the mandible. On the left side, the facial vein was draining into EJV, 42.4 mm below the angle of the mandible. The length of the neck was 137.8 mm. The mean distance of the superior and inferior labial veins, deep facial vein, and angular vein from the inferior orbital margin was 41.89±3.01, 52.31±3.72, 26.85±3.55 and 6.25±0.65 mm, respectively. Conclusion:A sound knowledge on variation of the course and termination of facial vein is very useful for oral and maxillofacial sur-

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Avoiding and Treating Blindness From Fillers

Abstract: Although the risk of blindness from fillers is rare, it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

Cited by 420 publications

References 43 publications

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

Facial Vein Variation: A Cadaveric Study

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