Incidence of Vascular Obstruction After Filler Injections

Schelke, Leonie; Decates, Tom; Kadouch, Jonathan; Velthuis, Peter

doi:10.1093/asj/sjaa086

Cited by 24 publications

(17 citation statements)

References 6 publications

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“…The accidental penetration of a blood vessel during active filler injection represents the triggering event that immediately precedes FIVO [ 116 , 117 ]. Blunt-tipped microcannulas and sharp hypodermic needles, both routinely employed in aesthetic injectable treatments, can potentially perforate vessel walls and initiate intraluminal inoculation of filler.…”

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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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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“…11 In the Netherlands, the likely under-reported incidence of vascular obstruction from filler injection is 1:6600. 12 Some vascular adverse effects are caused by the wrong injection site, excessive filler volume, improper indications, and incorrect injection techniques. 5 The most common mechanism of vascular occlusion is an intravascular embolism, which is indicated by pain, blanching, livedo pattern, delayed capillary refill time, blue or greyish discoloration, and coolness of the occluded area.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric Oxygen Therapy in Managing Minimally Invasive Aesthetic Procedure Complications: A Report of Three Cases

Oley¹,

Oley²,

Mawu³

et al. 2022

CCID

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Introduction Minimally invasive aesthetic procedures such as filler injections and thread lifts have gained popularity recently. Complications from these aesthetic procedures are difficult to avoid. This increasing public health concern requires a combination of effective therapeutic modalities. Hyperbaric oxygen therapy (HBOT) has generated favorable results in treating a diversity of wounds, inflammation, and infection. Case Presentations Three cases with complications arising from aesthetic procedures were described in this report. The patients were all female, with ages ranging from the late-twenties to mid-fifties. Two patients experienced complications from filler injections, one of which progressed to a parotid gland infection due to a placental extract filler while the other was caused by a hyaluronic acid filler. The third patient had notable excoriations and inflammation on both cheeks following a thread lift procedure. Alongside antibiotics and other symptomatic therapies, the patients received multiple, 90-minute HBOT sessions at 2.4 ATA over the course of one to two weeks. The wounds were frequently monitored to evaluate the healing progress. Discussion Complications from facial rejuvenation procedures can be disastrous. They expose the patient to the risk of developing vascular occlusions and skin infections that require prompt and effective treatment. Multiple treatment options (eg, frequently massaging the affected area, warm compresses, aspirin, and antibiotics) have been used to treat these complications. HBOT serves a valuable purpose in restoring adequate tissue perfusion in cases of filler-induced vascular occlusion and infection. Moreover, HBOT assists in restoring tissue injury and reducing inflammation following thread lift procedures. Conclusion HBOT has proven helpful as a treatment adjunct toward counteracting the effects of minimally invasive aesthetic procedures in several cosmetic-related cases.

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“…Common adverse effects include flushing, peripheral edema, dizziness, and headaches, and it is contraindicated in patients with a previous ST-elevation myocardial infarction [58] . The use of nifedipine was used in only one case report reported from the Netherlands [33] . Given the lack of supporting evidence, CCB are not generally recommended following CaHA-associated vascular occlusions.…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

Management of vascular complications following calcium hydroxylapatite filler injections: a systemic review of cases and experimental studies

Lindgren¹,

Welsh²

2022

Plast Aesthet Res

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Aim: Dermal fillers are increasingly popular procedures. Inadvertent intraarterial injection of fillers, particularly with calcium hydroxylapatite (CaHA), can result in devastating consequences. A systemic review was performed to summarize management strategies to treat CaHA-associated vascular complications. Methods: The methodology of this review was derived from The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). In addition, this paper presents a previously unreported case of a CaHA-associated vascular complication. Results: There were 32 articles describing 42 cases, plus our case included in this review. There were 15 cases of vision complications, 23 cases of non-vision complications, and 5 experimental studies. The most common injection sites reported were nasal region for vision complications (45%) and nasolabial folds for non-vision complications (40%). Of the 38 human cases, the most prevalent treatment choice was steroids (24 cases, 63%). Complete or near complete improvement was reported in 83% of non-vision complications and 40% of vision complications. There was no noticeable homogeneity in the management strategies and outcomes of the patients. Of the 5 experimental studies, no clear consensus on treatments was found. Conclusion: Vascular complications of CaHA are seemingly uncommon, but it is widely suspected that this is due to underreporting. While best management is prevention, preparation for a potential complication is equally important. Derived from CaHA literature, hyaluronic acid filler complication protocols, findings of this review, and personal experiences, this report proposes management strategies for CaHA-associated vascular complications. We hope these strategies provide a much-needed framework for injectors to refer to and utilize as needed.

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Incidence of Vascular Obstruction After Filler Injections

Cited by 24 publications

References 6 publications

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

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

Hyperbaric Oxygen Therapy in Managing Minimally Invasive Aesthetic Procedure Complications: A Report of Three Cases

Management of vascular complications following calcium hydroxylapatite filler injections: a systemic review of cases and experimental studies

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