The treatment of hyaluronic acid aesthetic interventional induced visual loss (AIIVL): A consensus on practical guidance

Abstract

These recommendations are based on current publications and or consensus view as there is still a lack of robust Level I data to support any particular intervention therapy.

A Consensus on Minimizing the Risk of Hyaluronic Acid Embolic Visual Loss and Suggestions for Immediate Bedside Management

“…This consensus group is not the first to attempt to improve safety and introduce a template of management for this rare but devastating adverse event from tissue fillers. 19 , 25 , 35 , 47 However, it was felt that this consensus group could add value to the literature by also defining a consent process and by suggesting preventative measures. This should begin with an understanding of the relative risk of each region in the face and extend into practical injection technique.…”

ABCs in the Prevention of Filler-induced Ocular Complications

“…Previous surgical history can alter arterial pathways, so much so that a few clinicians have recommended never treating a previously traumatized area with filler injections [32]. Alterations in the anatomical locations of vessels following surgical interventions, such as rhinoplasty, pose several concerns [33]: For instance, in augmentation of the nose, clinicians recommend injecting HA filler at the supraperiosteal layer, as it is well known that the dorsal nasal artery is located in the subcutaneous layer at the nose [34]. However, in many Asian patients, augmentation rhinoplasty is performed with silicone implants, and in such cases, HA filler cannot be injected at the supraperiosteal layer and should be injected more superficial than the implant, meaning it should be injected at the subcutaneous layer where the dorsal nasal artery might located, thereby posing a greater risk of vascular complications.…”

The use of periocular fillers in aesthetic medicine

“…Therefore, the authors postulate that in treating this region with hyaluronidase, the chance of successfully penetrating the arterial wall and therefore accessing the occlusion is highest. They recommend an initial dose of 1500 units, which canbe repeated hourly if necessary 71.…”