1
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Al-Alam Sansur S, Destang D. Use of the high-dose pulsed hyaluronidase protocol in the management of impending skin necrosis associated with hyaluronic acid fillers: a systematic review. Int J Oral Maxillofac Surg 2023; 52:79-87. [PMID: 35934566 DOI: 10.1016/j.ijom.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
Impending skin necrosis resulting from inadvertent intravascular injection of hyaluronic acid (HA) fillers can lead to tissue loss and significant scarring. In recent years, management trends have shifted from multimodal approaches to the sole use of high doses of hyaluronidase. The aim of this systematic review was to evaluate the effectiveness of the high-dose pulsed hyaluronidase management protocol in preventing skin necrosis and possible subsequent scarring. An online search of the bibliographic databases PubMed and Embase yielded 3039 articles. A total of 72 studies reporting 186 cases were found to be eligible for inclusion. The selection and evaluation process was done according to the PRISMA criteria. Included studies were assessed using the JBI and STROBE critical appraisal tools. The analysis of treatment outcomes was done according to the timing of treatment initiation and the type of intervention used. This review found that an immediate intervention using the high-dose pulsed hyaluronidase management protocol provided predictable and satisfactory outcomes. Initiating the protocol within 24 h of filler injection halted the progression of necrosis and prevented permanent sequelae. The conclusions are limited by the lack of a high level of evidence, since the only available sources of data are case reports and case series.
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Affiliation(s)
- S Al-Alam Sansur
- Specialized Clinic in Oral and Maxillofacial Surgery, Bethlehem, Palestine.
| | - D Destang
- Dermalogics Aesthetic Dermatology, Rodney Bay, St. Lucia
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2
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Lee AL, Chen YF, Yao WT, Liu YC, Yu CM, Yu CM, Tu CP, Huang WC, Tung KY, Tsai MF. Laser Doppler Imaging for Treating Vascular Complications from Procedures Involving Dermal Fillers: Case Series and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11091640. [PMID: 34573980 PMCID: PMC8468831 DOI: 10.3390/diagnostics11091640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 11/28/2022] Open
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.
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Affiliation(s)
- An-Li Lee
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Ying-Chun Liu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Burn Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Chih-Peng Tu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Medical Cosmetic Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan; (A.-L.L.); (Y.-F.C.); (W.-T.Y.); (Y.-C.L.); (C.-M.Y.); (C.-M.Y.); (C.-P.T.); (W.-C.H.); (K.-Y.T.)
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Correspondence: ; Tel.: +886-2-2543-3535; Fax: +886-2-2543-3642
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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.
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4
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The use of periocular fillers in aesthetic medicine. J Plast Reconstr Aesthet Surg 2021; 74:1602-1609. [PMID: 33546985 DOI: 10.1016/j.bjps.2020.12.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022]
Abstract
The periocular area is the first to display signs of ageing. Dermal fillers are an increasingly popular, minimally invasive method for facial rejuvenation. The eye is anatomically delicate and complex. Therefore, special consideration must be taken if dermal fillers are employed. This article examines the literature to assess the efficacy and safety of dermal fillers around the eye as well as the management of complications secondary to dermal filler use, such as oedema, granuloma formation, filler migration, xanthelasma, skin necrosis and visual loss. Hyaluronic acid (HA) is the most popular and commonly employed dermal filler for periocular use. It is effective, with good observer improvement and patient satisfaction (p<0.0001). Ninety percent of adverse events are mild in nature and self-resolve within 1 month. Malar oedema is a delayed complication unique to the periocular area, occurring in 11% of patients. This can be managed with use of hyaluronidase if a HA filler has been employed. Other complications, such as granuloma formation, filler migration and xanthelasma, have also been reported with variable management outcomes. Vascular adverse events include skin necrosis and visual loss. No Level 1 evidence exists for the management of visual loss. Two cases of visual restoration have been identified in the literature; however, this is rare.
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5
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Aviv U, Haik J, Weiss N, Berl A, Ofir H, Nardini G, Cleary M, Kornhaber R, Harats M. Treatment Algorithm for Hyaluronic Acid-Related Complication Based on a Systematic Review of Case Reports, Case Series, and Clinical Experience. Craniomaxillofac Trauma Reconstr 2020; 13:313-328. [PMID: 33456703 DOI: 10.1177/1943387520952687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design Systematic review of hyaluronic acid (HA)-related complications. Objective To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection. Methods This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients. Results The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects. Conclusion Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection.
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Affiliation(s)
- Uri Aviv
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,These authors contributed equally to this work
| | - Josef Haik
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia.,These authors contributed equally to this work
| | - Nathaniel Weiss
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Ariel Berl
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Hagit Ofir
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michelle Cleary
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia
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6
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Kim BJ, You HJ, Jung I, Kim DW. Ophthalmoplegia with skin necrosis after a hyaluronic acid filler injection. J Cosmet Dermatol 2020; 19:1307-1310. [PMID: 32281282 DOI: 10.1111/jocd.13403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 11/26/2022]
Abstract
Hyaluronic acid filler injection is commonly used for aesthetic purposes. However, many clinicians neglect the possibility of developing vascular occlusion and its devastating sequelae. Besides visual loss after iatrogenic ophthalmic artery occlusion, ophthalmoplegia without blindness is rare but may occur. Here, we report a 23-year-old woman with ptosis, lateral deviation of the right eye, and skin necrosis after hyaluronic acid filler injection. After hyaluronidase injection and steroid pulse therapy, ptosis and eye movement were completely restored. Skin necrosis was treated with a human epithelial growth factor ointment, followed by Nd:YAG laser. Complete healing with minimal scar was achieved.
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Affiliation(s)
- Beom-Jun Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ileok Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
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7
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Graue G, Ochoa Araujo DA, Plata Palazuelos C, Núñez Medrano JÁ, López San Juan FJ, Sánchez Pereda D, Capiz Correa DR, de Velasco L. The M.A.STE.R.S algorithm for acute visual loss management after facial filler injection. J Cosmet Dermatol 2020; 19:2859-2866. [PMID: 32270627 DOI: 10.1111/jocd.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To propose an algorithm of treatment for sudden visual loss following filler injections and perform an English-written literature search for assignment of evidence level and grade recommendation. METHODS Algorithm of treatment includes ocular physical Maneuvers, hyAluronidase administration, intravenous STEroids, intraocular pressure Reduction, and Supplemental Oxygen (M.A.STE .R.S) based on previous acute management reports. Special consideration for algorithm buildup was made for ophthalmic diseases that share physiopathological features such as central retinal artery occlusion, systemic vasculitis affecting vision, and acute glaucoma. Finally, a systematic cross-review of the reported cases with visual loss was done to identify the level of evidence and grant a recommendation grade. RESULTS A search through PubMed and Medscape databases for English-written scientific papers using the terms facial filler, retinal artery occlusion, management, treatment, complications, and adverse events quoted a total of 46 papers (190 cases) which were then analyzed. A high variability on management for treatment of sudden visual loss after facial filler injections was observed. This was attributed partially to the great diversity of medical specialists performing cosmetic facial procedures such as dermatologists, plastic surgeons, esthetic doctors and ophthalmologists, and the lack of high evidence level studies. CONCLUSIONS The proposed algorithm provides an initial guideline based on prior literature reports and physiopathology involving facial filler injection complications. Analysis identified 22 successfully treated cases with vision recovery (11.57%). Ocular physical maneuvers had the best evidence-based level and grade recommendation (A) for the management of acute vision loss secondary to facial filler injections.
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Affiliation(s)
- Gerardo Graue
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico.,Periocular Cosmetic Clinic, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
| | - Dora Aline Ochoa Araujo
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
| | | | | | | | | | - Daniel Raúl Capiz Correa
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico.,Ophthalmic Pathology Division, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
| | - Leopoldo de Velasco
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico.,Periocular Cosmetic Clinic, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
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8
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9
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The Role of Hyaluronidase for the Skin Necrosis Caused by Hyaluronic Acid Injection-Induced Embolism: A Rabbit Auricular Model Study. Aesthetic Plast Surg 2019; 43:1362-1370. [PMID: 31139914 DOI: 10.1007/s00266-019-01398-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Skin necrosis is considered the most serious complication of hyaluronic acid dermal filler injection procedures. To effectively treat skin necrosis, hyaluronidase injection is one of the essential preventative treatments, and yet optimal complication management remains an unmet need. Therefore, this paper investigates the effects of hyaluronidase injection timing on the treatment of skin necrosis. METHODS In an in vitro experiment, the carbazole method was used to determine the degradation time of hyaluronic acid gels in a large volume of hyaluronidase. In vivo experimental rabbit ear models were developed to simulate the skin necrosis caused by hyaluronic acid and the test animals distributed into five groups. Except one control group, the other four groups were injected with a large volume of hyaluronidase as treatment at 2 h, 4 h, 8 h and 16 h, respectively, after models were built. The necrosis degree of models was analyzed with necrotic area and histologic examination on the postoperative 7th day. Besides, temperatures of rabbit ears were observed to demonstrate the healing process of flap models. RESULTS The average necrotic area of flaps in the 2-h and 4-h injection groups showed a significant difference compared with that of the control group (p < 0.05; p < 0.05). The histologic examination showed that there were HA embolisms, vascular thrombolytic recanalization and arteriovenous thromboses in the survival area. In addition, the mean temperatures of the rabbit ear flaps fluctuated over time and showed clear differences between distal and proximal parts. CONCLUSIONS The area of flap necrosis positively correlates with injection timing of the large volume of hyaluronidase. More importantly, when injection timing is within 4 h, treatment effectiveness will be significantly improved. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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10
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Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J 2019; 39:662-674. [PMID: 30805636 DOI: 10.1093/asj/sjz053] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sudden loss of vision secondary to filler treatments is a rare but catastrophic complication. OBJECTIVES The aim of this study was to update the published cases of blindness after filler injection that have occurred since we published our review of 98 cases in 2015, and to discuss prevention and management strategies. METHODS A literature review was performed to identify all cases of visual complications caused by filler injection identified between January 2015 and September 2018. RESULTS Forty-eight new published cases of partial or complete vision loss after filler injection were identified. The sites that were highest risk were the nasal region (56.3%), glabella (27.1%), forehead (18.8%), and nasolabial fold (14.6%). Hyaluronic acid filler was the cause of this complication in 81.3% of cases. Vision loss, pain, ophthalmoplegia, and ptosis were the most common reported symptoms. Skin changes were seen in 43.8% of cases and central nervous system complications were seen in 18.8% of cases. Ten cases (20.8%) experienced complete recovery of vision, whereas 8 cases (16.7%) reported only partial recovery. Management strategies varied greatly and there were no treatments that were shown to be consistently successful. CONCLUSIONS Although the risk of blindness from fillers is rare, practitioners who inject filler should have a thorough knowledge of this complication including prevention and management strategies. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Katie Beleznay
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Humphrey
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
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11
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Zambacos GJ, Hapsas DA, Mandrekas AD. Glabella impending skin necrosis: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1460-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Fakih-Gomez N, Orte-Aldea MDC, Poonja K, Khanna D. Hyaluronic Acid Filler Emergency Kit. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/0748806818825214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Widespread use of facial filler has led to a rise in reports of associated complications. The aim of this kit is to encompass all needed items to treat the patient and to be organized and prepared to provide correct treatment in urgent situations. A search was performed to gather information on the treatment of complications that occur after injection of soft tissue fillers. The search included reports published in English up to June 2018. We focused on reports of complications arising from emergent/urgent situations following the use of hyaluronic acid injectables; these included filler embolization resulting in impending skin necrosis, blindness or partial loss of vision, and anaphylaxis. We collated treatment of emergent complications from our search of published articles. There were 2 described protocols for filler complications in the literature. One protocol, the “old” protocol, was based on a low dose of hyaluronidase with longer intervals of injections and ancillary treatment. This protocol did not show good results in comparison with the “new” protocol, which was needed to improve these results. The new protocol demonstrated that a high dose of hyaluronidase had better efficacy; this protocol involves hourly injections with no ancillary treatment required except for aspirin. We propose a filler emergency kit (FEK) to deal with complications of hyaluronic acid fillers according to the new protocol to manage the stresses caused by these situations. Every physician needs to be prepared for any potential complication; therefore, there is a need to have a FEK as a crash kit in the clinic to avoid distressing the physician and the patient.
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13
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Ciancio F, Tarico MS, Giudice G, Perrotta RE. Early hyaluronidase use in preventing skin necrosis after treatment with dermal fillers: Report of two cases. F1000Res 2018; 7:1388. [PMID: 31001410 PMCID: PMC6449787 DOI: 10.12688/f1000research.15568.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 11/20/2022] Open
Abstract
Injection of dermal fillers, like hyaluronic acid (HA), is a safe procedure, with few and transient side effects such as erythema, bruising and swelling etc. The aim of this report is to provide our protocol for the early treatment of necrotic complications after facial treatment with dermal fillers. We present two cases of skin suffering of the face after dermal infiltration of HA, treated successfully with our early protocol. Our protocol includes the early infiltration of hyaluronidase in the treated areas. We start with infiltration of hyaluronidase distributed over the area to be treated through micro-injections with dosage 40 IU per cm 2. Our protocol includes the use of systemic corticosteroids for 4 days, anti-aggregation therapy, oral antibiotic, topical cream with nitric oxide and compresses with gauze and warm water. In the skin complications after dermal filler treatment, marked pain and characteristic reticulated erythema in the skin distribution of the affected vessels is often developed. Due to the implementation of our protocol in these patients, we managed to avoid an irreversible necrotic complication of the face in both cases. In this report, our protocol was compared with results published in the literature and allowed us to avoid complications such as skin necrosis with permanent damage.
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Affiliation(s)
- Francesco Ciancio
- Department of Plastic and Reconstructive Surgery, University of Bari, Bari, 70124, Italy
| | - Maria Stella Tarico
- Department of Plastic and Reconstructive Surgery, University of Catania, Catania, 95100, Italy
| | - Giuseppe Giudice
- Department of Plastic and Reconstructive Surgery, University of Bari, Bari, 70124, Italy
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14
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Ciancio F, Tarico MS, Giudice G, Perrotta RE. Early hyaluronidase use in preventing skin necrosis after treatment with dermal fillers: Report of two cases. F1000Res 2018; 7:1388. [PMID: 31001410 PMCID: PMC6449787 DOI: 10.12688/f1000research.15568.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 10/07/2023] Open
Abstract
Injection of dermal fillers, like hyaluronic acid (HA), is a safe procedure, with few and transient side effects such as erythema, bruising and swelling etc. The aim of this report is to provide our protocol for the early treatment of necrotic complications after facial treatment with dermal fillers. We present two cases of skin suffering of the face after dermal infiltration of HA, treated successfully with our early protocol. Our protocol includes the early infiltration of hyaluronidase in the treated areas. We start with infiltration of hyaluronidase distributed over the area to be treated through micro-injections with dosage 40 IU per cm 2. Our protocol includes the use of systemic corticosteroids for 4 days, anti-aggregation therapy, oral antibiotic, topical cream with nitric oxide and compresses with gauze and warm water. In the skin complications after dermal filler treatment, marked pain and characteristic reticulated erythema in the skin distribution of the affected vessels is often developed. Due to the implementation of our protocol in these patients, we managed to avoid an irreversible necrotic complication of the face in both cases. In this report, our protocol was compared with results published in the literature and allowed us to avoid complications such as skin necrosis with permanent damage.
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Affiliation(s)
- Francesco Ciancio
- Department of Plastic and Reconstructive Surgery, University of Bari, Bari, 70124, Italy
| | - Maria Stella Tarico
- Department of Plastic and Reconstructive Surgery, University of Catania, Catania, 95100, Italy
| | - Giuseppe Giudice
- Department of Plastic and Reconstructive Surgery, University of Bari, Bari, 70124, Italy
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15
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Mild Complications or Unusual Persistence of Porcine Collagen and Hyaluronic Acid Gel Following Periocular Filler Injections. Ophthalmic Plast Reconstr Surg 2018; 34:e143-e146. [DOI: 10.1097/iop.0000000000001029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Rejuvenating Effect and Tolerability of an Auto-Cross-Linked Hyaluronic Acid on Décolletage: A Pilot Prospective Study. Aesthetic Plast Surg 2018; 42:520-529. [PMID: 29218478 DOI: 10.1007/s00266-017-1022-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/29/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A novel auto-cross-linked hyaluronic acid formulation (HA-ACP) has been proposed as a treatment for skin rejuvenation. This prospective pilot study aims to assess its tolerability and performance in the treatment of skin aging of the décolletage. METHODS Fifteen women (mean age 49.0 ± 8.0 (range 30-65)) who complained about the appearance of their décolletage were prospectively enrolled and treated with three sets of HA-ACP (IAL-SYSTEM ACP®) intradermal injections, administered three weeks apart. Control visits followed at 80 and 120 days from enrollment. The rejuvenating effect was assessed using the Beagley-Gibson and Fabi-Bolton scores. The investigators and the subjects also subjectively assessed skin appearance using a 1-10 scale. The rejuvenating effect and its persistence were assessed comparing the scores collected at the different experimental times by means of Wilcoxon rank tests. Adverse events and their duration were recorded and compared to those reported in the literature. RESULTS The HA-ACP formulation provided a significant improvement according to the Beagley-Gibson score (p < 0.005) at all time points. At the 120-day follow-up, the Fabi-Bolton score was significantly improved with respect to baseline (p < 0.05). The rejuvenating effect persisted unaltered between the 80-day and the 120-day visits. At the 120-day visit, the subjects' and investigators' subjective scores were between 8 and 10 in most cases. No unexpected adverse effects were observed. All adverse effects were well tolerated and disappeared over a short period. CONCLUSIONS The HA-ACP treatment under investigation is safe, well tolerated, and provides effective and long-lasting décolletage rejuvenation. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Povolotskiy R, Oleck NC, Hatzis CM, Paskhover B. Adverse Events Associated With Aesthetic Dermal Fillers: A 10-Year Retrospective Study of FDA Data. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/0748806818757123] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study investigates the reported adverse events arising with various aesthetic dermal fillers by type and brand name. It reveals rare but dangerous complications associated with a widely used elective procedure. The authors queried and compiled the MAUDE database for injury cases reported with aesthetic dermal fillers between January 2007 and July 2017. A total of 5024 individual cases were then queried for adverse events using specific keywords and grouped into categories for analysis. Categories and keywords were determined after querying a large portion of the samples for common adverse events. The most common complications associated with aesthetic dermal filler use were nodule formation (2952 cases), infection (2575 cases), inflammation (711 cases), allergic complications (594 cases), and vascular complications (590 cases). The most common fillers associated with an adverse event were Juvederm Voluma XC (1050 cases), Sculptra (879 cases), and Radiesse (620 cases). These fillers represent 3 filler types: hyaluronic acid fillers, poly-l-lactic acid fillers, and calcium hydroxylapatite fillers, respectively. Injectable dermal fillers are frequently used cosmetic products around the world. To safely and effectively use these products, health care providers and patients must be fully aware of the proper techniques and risks associated with each product. Many of the complications reported were known to be possible, but others were previously only reported as individual case studies. The rates of occurrence for both well-known and lesser known complications may be higher than originally thought.
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Affiliation(s)
- Roman Povolotskiy
- Department of Otolaryngology – Facial Plastics, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Nicholas C. Oleck
- Department of Otolaryngology – Facial Plastics, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Christopher M. Hatzis
- Department of Otolaryngology – Facial Plastics, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology – Facial Plastics, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA
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