Impending skin necrosis after dermal filler injection: A “golden time” for first-aid intervention

Hong, Ji Yeon; Seok, Joon; Ahn, Ga Ram; Jang, Yoon Jung; Li, Kapsok; Kim, Beom Joon

doi:10.1111/dth.12440

Cited by 27 publications

(14 citation statements)

References 6 publications

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“…In an experimental study about free flap skin survival, more than 9 hours of warm ischemia was found to severely affect the survival of the skin component. 9 Although most studies suggest injection of hyaluronidase, there is no unanimity on dosage and the interval between 2 doses. 10 It can be injected on an hourly basis till the endpoint of treatment showing reperfusion of skin and correction of blanching/livedo.…”

Section: Discussionmentioning

confidence: 99%

Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase

Loh¹,

Phoon²,

Phua

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Summary:Facial fillers are becoming increasingly popular as aesthetic procedures to temporarily reduce the depth of wrinkles or to contour faces. However, even in the hands of very experienced injectors, there is always a small possibility of vascular complications like intra-arterial injection of filler substance. We present a case report of a patient who developed features of vascular obstruction in right infraorbital artery and tell-tale signs of impending skin necrosis, after hyaluronic acid filler injection by an experienced injector. The diagnosis of a vascular complication was made quickly with the help of clinical features like blanching, livedo reticularis, and poor capillary refill. Patient was treated promptly with “high-dose pulsed hyaluronidase protocol” comprising three 1,000-unit pulses of hyaluronidase, administered hourly. There was no further increase in size of the involved area after the first dose of hyaluronidase. All of the involved area, along with 1 cm overlapping in uninvolved skin area, was injected during each injection pulse, using a combination of cannula and needle. Complete reperfusion and good capillary filling were achieved after completion of 3 pulses, and these were taken as the end-point of high-dose pulsed hyaluronidase treatment. Immediate skin changes after filler injections, as well as after hyaluronidase injections and during the 3-week recovery period, were documented with photographs and clinical notes. Involved skin was found to have been fully recovered from this vascular episode, thus indicating that complete recovery of the ischemic skin changes secondary to possible intra-arterial injection could be achieved using high-dose pulsed hyaluronidase protocol.

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Section: Discussionmentioning

confidence: 99%

Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase

Loh¹,

Phoon²,

Phua

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…Then it The compression of suprathroclear, supraorbital or glabellar arteries can lead to glabellar necrosis, but also in this case in the opinion of the authors quit all the cases of necrosis are due to an intraarterial injection [18]. This is why luckily a good injection technique and the right plane of injection can preserve physicians from this risk [13] [ Figure 5].…”

Section: Facial Arterymentioning

confidence: 92%

“…National Library of Medicine's PubMed database was utilized to have an overview of the effi cacy, safety and outcomes and to fi nally fi nd out the optimal use of hyaluronidase.  Use hyaluronic acid based product that is a temporary and biodegradable product and can be in part break down by hyaluronidase [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

Section: Guidelinesmentioning

confidence: 99%

Ischemical Problems after Filler Injections: Anatomical Details and Practical Guide Lines to Avoid Disasters

Alessio¹,

Melania²,

Ivanov³

2017

Arch Anat Physiol

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Introduction: Soft-tissue fi ller injection is a very common procedure all around the world. Although the safety profi le for these products is favorable, adverse events can occur, ranging from mild to severe in intensity. The most disastrous complication reported is accidental intra-arterial fi ller injection or in rare case due to the compression of the vessel associated with tissue injury and necrosis. Objectives:The authors performed a literature search to identify the facial sites most prone to severe complications, especially due to anatomical structure. After a review of these complications they discuss preventive measures in order to avoid ischemical problems after fi ller injections and try to give a prompt intervention guidelines to manage this kind of complication and signifi cantly decrease the risk of long term sequelae. Method:The National Library of Medicine, the Cochrane Library, and Ovid MEDLINE were searched, and relevant articles were retrieved based on specifi c criteria. The complications reviewed included softtissue necrosis, fi ller embolization and visual impairment.Results: Data collected from these case reports showed that the most common injection sites for necrosis are the glabella, the nose and the nasolabial fold. Blindness was most often associated with injection of the glabella. A thorough understanding of the facial vascular anatomy and a good injection technique reduce the risk of vascular occlusion. Conclusions:Although soft-tissue fi llers are a popular choice for minimally invasive rejuvenation of the face, physicians should be aware of the serious potential ischemical adverse event risks by using a correct technique of injection based on a good knowledge of anatomy and good instruments trying to prevent and/or manage its.

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“…Other reports have estimated treatment with 500 units of high-dose pulsed hyaluronidase for a vascular territory similar to the present case. Therefore, we adhered to that protocol [9].…”

Section: Daily Follow-upmentioning

confidence: 99%

Successful management of nose arterial occlusion and impending skin necrosis after filler injection

Ling¹

2019

J Cosmet Med

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The growing use of dermal fillers, specifically the use of hyaluronic acid, may be explained by their effectiveness and versatility and their favorable safety profiles. Nevertheless, early and late complications with varying levels of severity may occur. The incidence of complications is low; however, more severe events such as skin ischemia and necrosis, and even visual loss may occur. The main objective of this case report on intravascular filler injection was to provide information on early signs of ischemic skin necrosis to physicians administering cosmetic fillers. This knowledge will facilitate timely management of symptoms, and enable treatment with hyperbaric oxygen therapy (HBOT) to prevent permanent scarring. A case note study of a single 41-year-old female who underwent a combination of treatments including the "high-dose pulsed hyaluronidase" technique, intravenous dexamethasone, HBOT, open dressing with normal saline, and bactigras dressing. Early recognition and immediate application of the correct combination of treatments for intravascular filler injury prevented further skin necrosis, permanent scarring, and the requirement for surgical reconstruction. Recently, as the application of dermal fillers for soft-tissue augmentation has increased, the number of cases reporting adverse reactions has also increased. The most severe and alarming early complication is vascular occlusion. Thus, it is crucial that physicians are familiar with the anatomy of the treated region, type of product used, correct application technique, and possible adverse events to allow immediate recognition and treatment.

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Impending skin necrosis after dermal filler injection: A “golden time” for first-aid intervention

Cited by 27 publications

References 6 publications

Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase

Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase

Ischemical Problems after Filler Injections: Anatomical Details and Practical Guide Lines to Avoid Disasters

Successful management of nose arterial occlusion and impending skin necrosis after filler injection

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