Skin Necrosis and Vision Loss or Impairment After Facial Filler Injection

Abstract

Purpose of the present study is to objectively evaluate the number of severe vascular complications, represented by skin necrosis and vision loss or impairment, following facial filler injection. The investigators implemented a review of the literature including articles published on PubMed database without limitation about year of publication, including all reports concerning skin necrosis and vision loss or impairment related to the injection of fillers for cosmetic uses. The search highlighted 45 articles and a total of 164 cases of skin necrosis and vision loss or impairment after injection of different substances. The injection site most frequently associated with complications was the nose (44.5%), followed by glabella (21%), nasolabial fold (15%), and forehead (10%). Results of the present study suggest that injectable filler can cause severe complications even in expertized hands. Treatments in the new defined “Dangerous triangle” must be carefully carried out. Despite our expectations, the highest rates of sever adverse events have been associated with autologous fat transfer practice.

Tissue Fillers for the Nasolabial Fold Area: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…As Dr. Foad Nahai mentioned in his letter, many patients believe that fillers are 100% safe and tend to overlook potential dangers [74]. There are multiple reports describing cases of vascular occlusion after injecting tissue filler in the nasolabial fold-area [75][76][77]. The risk seems to be higher in patients with history of cosmetic rhinoplasty [78].…”

Clinical Experience with PEGylated Hyaluronic Acid Fillers: A 3-year Retrospective Study

“…Moreover, HA injections, nowadays, are also used for post-surgical corrective procedures, are able to modify muscle contraction (e.g., gummy smile treatment), and so on [17], [18], [19], [20], [21]. HA fillers are the only ones that can be reversed whenever it is needed just injecting HYAL, this confers a really high safety profile to these medical devices and probably this is the reason why, over time, other resorbable substances introduced in the market did not gain the same approval [3], [4]. Since the introduction of HA filler the cross-linking agent main used was represented by BDDE [8]; some attempts to use Divinyl Sulfone (DVS) as cross-linker among HA chains were published, although DVS crosslinker content within the gels in general, stimulate a mild subcutaneous inflammatory response in vivo and VCAM-1 expression by endothelial cells (ECs) cultured atop [22].…”

“…Hyaluronic acid (HA) fillers are the most used worldwide, this is mainly related to the high biocompatibility and safety profile of HA, moreover, HA is the only substance that can be "dissolved" thanks to the use of hyaluronidase (HYAL) that induce an enzymatic hydrolytic effect [1], [2], [3], [4], [5]. The possibility to hydrolyze HA, once injected, is useful in cases of unpleasant results, however, its main advantage is related to the possibility to treat unwanted side effects such as nodules, and especially vascular problems such as impending necrosis [6], [7].…”

Polyacrylamide Injection vs. Polylactic Acid in HIV Related Lipodystrophy: A RCT Systematic Review

“…These complications range from bruising, to oedema, to a small bump underneath the skin to more serious consequences such as vascular occlusion, which can lead to skin necrosis or permanent vision loss, depending on the injected vessel. In cases of embolization, proper and prompt use of hyaluronidase is mandatory [53][54][55][56].…”