Laser Doppler Imaging for Treating Vascular Complications from Procedures Involving Dermal Fillers: Case Series and Literature Review

Abstract

Vascular occlusion is a rare but severe complication of dermal filler injections. Early treatment of this complication produces better outcomes. Current diagnostic methods for vascular occlusion in the skin are subjective and imprecise; these include capillary refill time, skin color, and reports of pain. This study aimed to assess the use of laser Doppler imaging (LDI) in the evaluation and treatment of vascular complications caused by dermal filler injections. This retrospective study used laser Doppler imaging (LDI) in 13 patients who developed vascular occlusion after facial dermal filler injections, with subsequent follow-up. The precise areas of perfusion observed on LDI were compared with the findings of clinical and photographic evaluation. The results showed that LDI accurately identified areas of vascular occlusion and improved treatment precision among these thirteen patients. The procedure was more precise than visual inspection or photographic evidence. Satisfactory outcomes were achieved for all patients, and no procedure-related complications were reported. Collectively, LDI provides fast, noninvasive, and accurate delineation of areas of vascular occlusion caused by complications of dermal filler injections and avoids several subjective shortcomings of visual and photographic evaluations. Thus, LDI effectively tracks treatment outcomes. However, large-scale studies are required to confirm the present findings.

Ischemic complications of dermal fillers

“…Firstly, ultrasound has successfully determined that the needle or cannula is positioned in the correct plane and not within or near a vessel [111] . Schelke et al discussed how the use of doppler ultrasound can help distinguish vessels as well as the direction of blood flow [Figure 6] [112] . Rocha et al recommended that once the needle or cannula is determined to be in the correct location, the filler can be injected without aspiration [111] .…”

“…Doppler ultrasound may be able to be used to detect the lack of perfusion, and in rare cases, an ischemic vessel may be able to be injected with hyaluronidase under ultrasound guidance. Schelke et al reported on a case of how, upon crusting under the lip after upper lip augmentation, 150 U of hyaluronidase was injected with ultrasound guidance [112] . A case in which ultrasound was used to inject hyaluronidase into a visualized filler deposit is seen in Figure 8.…”