Verification of Embolic Channel Causing Blindness Following Filler Injection

Tansatit, Tanvaa; Moon, Hyoung Jin; Apinuntrum, Prawit; Phetudom, Thavorn

doi:10.1007/s00266-014-0426-z

Cited by 47 publications

(31 citation statements)

References 11 publications

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“…20-1000 µm), it may become lodged, causing distal tissue necrosis. (2) If hyaluronic acid embolism occurs, there is a chance that it can be dissolved by hyaluronidase administration within the window period of 60-90 minutes. (11) …”

Section: Immediate Actionmentioning

confidence: 99%

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Prevention and management of vision loss relating to facial filler injections

Loh¹,

Chua²,

Lee³

et al. 2016

smedj

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Section: Immediate Actionmentioning

confidence: 99%

“…(1) Very rarely, severe complications such as skin necrosis, visual loss and stroke have been reported. (2) It is believed that these events are caused by accidental intravascular administration of filler material leading to ischaemia or infarction distal to the point of entry.…”

Section: Introductionmentioning

confidence: 99%

Prevention and management of vision loss relating to facial filler injections

Loh¹,

Chua²,

Lee³

et al. 2016

smedj

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“…Therefore, according to the actual experience of many clinicians, a retrograde embolization mechanism was widely accepted. In 2015, the specific mechanism of retrograde embolism was discussed in detail in Tansatit's article [13,14]. Using a dye, human bodies were perfused through both the superficial temporal artery and the facial artery, and the dye came out from the globes.…”

Section: Discussionmentioning

confidence: 99%

“…To verify the retrograde embolism theory, Tanvaa et al [13,14] carried out experiments on corpses. They demonstrated that the injectant reached the ophthalmic artery system from the facial artery in most of the experimental cadavers under a certain injection pressure, which heightened the surgeons' concerns about the risk of facial filling.…”

Section: Introductionmentioning

confidence: 99%

Exploring the Possibility of a Retrograde Embolism Pathway from the Facial Artery to the Ophthalmic Artery System In Vivo

et al. 2017

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“…9,10,11 The nasolabial and the frontotemporal units are known to be danger zones due to large-core cutaneous arteries susceptible to accidental cannulation, the facial and the superficial temporal arteries. 12 Young patients may have higher risk of blindness because healthy skin has abundant cutaneous arterial anastomoses. If the patient complains of sudden ocular pain or visual loss, however, injection must cease immediately.…”

Section: Intra-arterial Embolismmentioning

confidence: 99%

31 Management of Facial Filler Injection Complications

Jin¹

2016

Aesthetic Plastic Surgery of the East Asian Face

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calcium hydroxyapatite and poly-L-lactic acid are excellent for their volumetric effect. 2 An understanding of facial anatomy, especially skin thickness and vessels, is also crucial to reduce complications. Skin thickness varies among different anatomic regions, and requires different techniques depending on filler type. Generally, human collagen should be placed in the middermis, and medium-length hyaluronic acid products should be placed in the deep dermis. Calcium hydroxyapatite is injected at the dermal subcutaneous border, while poly-L-lactic acid and fat are injected into the subcutis. 2 Since the eyelids, periorbita, and nasal dorsum are known to have a very thin dermis, special care should be taken when injecting into these regions not to introduce lumpiness, nodules, or potential granulomas. For the novice, sometimes it is better to err on the side of filler placement that is too deep rather than too superficial even though the augmentation effect may not be as apparent. 2,3 The rich network of blood vessel in the face is by and large a blessing, but it can increase the chances of bruising, hematoma, or embolism-related complications. The glabellar and nasolabial regions are regarded as high-risk facial units ■ IntroductionA filler is any material that can augment volume when injected into the body, and is usually available in an injectable form. Well-known fillers include hyaluronic acid products, collagen, paraffin, and liquid silicone. Although most of the fillers in the market are known to have a good safety profile, complications can occur occasionally since they are artificial implants that can induce a foreign-body reaction. Because injection is a blind procedure, the physician is unable to see exactly where the filler is placed. According to a study of 286 patients injected with hyaluronic acid gel, there was a complication rate of ~ 5%. 1 However, most complications can be prevented by selecting safe products and performing the procedure in an appropriate manner. Although fillers can be injected into any region of the body theoretically, each filler has a specific niche in terms of its purpose. For instance, human collagens and the medium hyaluronic acid products such as Restylane (Galderma) and Juvederm Ultra (Allergan) are appropriate for correcting fine rhytides in thin-skin areas while heavier fillers such as Pearls • Skin thickness varies across different anatomic regions. Since the eyelids, periorbital area, and nasal dorsum are known to have a very thin dermis, special care should be taken while injecting into these regions not to create lumpiness, nodules, or granulomas.• The glabellar and nasolabial regions are regarded as high-risk facial units in which surgery can lead to serious vascular complications.• Fillers should be placed in the appropriate layer of skin. Too superficially injected fillers can result in unevenness and visibility. Too deeply injected fillers can be under effective at changing shapes.• Given that most faces are slightly asymmetric, it is important to visually che...

show abstract

Verification of Embolic Channel Causing Blindness Following Filler Injection

Abstract: Under some specific conditions favoring embolism, persistent interarterial anastomoses between the face and the eye allowed filler emboli to flow into the globe causing ocular complications.

Cited by 47 publications

References 11 publications

Prevention and management of vision loss relating to facial filler injections

Prevention and management of vision loss relating to facial filler injections

Exploring the Possibility of a Retrograde Embolism Pathway from the Facial Artery to the Ophthalmic Artery System In Vivo

31 Management of Facial Filler Injection Complications

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