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

Abstract

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.

“Patterns of filler-induced facial skin necrosis: A systematic review of 243 cases and introduction of the F.O.E.M. scoring system and grading scale.”

“…The literature and photographic searches yielded 243 individual photographic cases with a total of 738 photographs available for review and scoring using the FOEM system. Information relating to patient demographics was available in 199 cases, filler material and injection site in 195 cases, and symptoms in 149 cases from 120 publications 23–143 from which data extraction was performed and are listed in Table 2. The patient population was predominantly female (88%), with an average age of 38.2 years.…”

Hyperbaric Oxygen and Outcomes Following the Brain Injury: A Systematic Review

“…The therapeutic effects of HBOT are attributed to several mechanisms, including increased oxygen delivery to tissues, improved tissue oxygenation, neovascularization promotion, wound healing enhancement, inflammation reduction, and neuroprotection [12][13][14][15][16][17].…”