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Ahn HS, Kim HM, Oh W, Yi KH, Kim J, Kim HJ. Singular entry point technique for forehead and temple filler augmentation: Anatomical and clinical perspectives. J Cosmet Dermatol 2024. [PMID: 38837504 DOI: 10.1111/jocd.16411] [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: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The depressed volume of the forehead and temple is resolved by filler injection. However, the current method has the potential to cause pain and side effects in patients, depending on the skill of the clinician. Therefore, this study proposes a new method for safer and simpler injection using only one injection entry point. METHODS Using the novel injection method, the filler was injected into the forehead and temple regions in three unembalmed cadavers and two healthy Korean volunteers. The cannula and filler locations were identified using dissection, ultrasonography, and three-dimensional (3D) scanning. RESULTS Ultrasonographic images and dissection results showed that the filler injected into the cadavers was in the target layer. The cannula and filler were located on the layer as the supraperiosteal layer on the forehead and the supra deep temporal fascia layer in the temple. Finally, 3D scanning images showed that the filler was injected precisely and effectively into the forehead and temples of the volunteer who underwent the procedure. CONCLUSIONS This method can reduce pain and minimize externally visible wounds caused by injections. The injected filler was naturally connected from the forehead to the temple and maintained for around 3 months. Additionally, it is possible to inject fillers into the forehead and temple at a constant and safe depth without requiring specific skills. It is expected that this method will become a universal method because it minimizes the burden on both patients and clinicians.
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Affiliation(s)
- Hyo-Sang Ahn
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | | | | | - Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Maylin Clinic, Apgujeong Seoul, Korea
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
- Department of Electric and Electronical Engineering, College of Engineering, Yonsei University, Seoul, Korea
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Farollch-Prats L, Braz A, Urdiales-Gálvez F, de la Guardia C, Nazari A. Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach. J Cosmet Dermatol 2024. [PMID: 38769652 DOI: 10.1111/jocd.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Expansion of the aesthetic treatment armamentarium with novel injectable products has greatly improved our ability to reshape and enhance the facial profile. However, full-face "profiloplasty" with injectables remain a nascent concept and is insufficiently considered in daily practice. While techniques have been widely published for treating the individual facial areas that constitute an attractive profile-including the forehead, nose, lips, jawline, and chin-the literature remains fragmented on more universal methods for profile improvement. AIMS To collate disparate knowledge on profile optimization with injectables, and define a holistic, practical, and user-friendly approach to profiloplasty and facial contouring. METHODS Consideration is given to key anatomical aspects and the changes that occur with age; patient assessment parameters for planning profiloplasty; and the technical specifications, product selection, and essential safety considerations for minimizing the risk of complications and optimizing the effectiveness of treatment. RESULTS Relevant case studies are presented. CONCLUSIONS Holistic approaches of this type are essential if we are to maximize the potential of full-face treatment with injectables-both now and in the future.
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Affiliation(s)
| | - André Braz
- Dermatología Láser Cosmiatria Clinic, Rio de Janeiro, Brazil
| | | | - Carola de la Guardia
- Global Aesthetics Medical Affairs, Allergan Aesthetics, an AbbVie Company, Madrid, Spain
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Joo HJ, Kim DH. Posterior Ischemic Optic Neuropathy Following Skin Booster Injection. J Neuroophthalmol 2024:00041327-990000000-00621. [PMID: 38595300 DOI: 10.1097/wno.0000000000002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Hye Jun Joo
- Department of Ophthalmology (HJJ, DHK), Seoul National University Hospital, Seoul, South Korea; and Department of Ophthalmology (DHK), Seoul National University College of Medicine, Seoul, South Korea
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Botha VE, Insull EA. Causes and management of sight threatening complications of dermal filler injections: A review. Clin Exp Ophthalmol 2024; 52:365-373. [PMID: 38380782 DOI: 10.1111/ceo.14362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/16/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024]
Abstract
Injectable dermal fillers continue to increase in popularity in aesthetic medicine. Although rare, vision loss secondary to filler injections is a devastating complication associated with a poor visual prognosis. The mechanism for vision loss is thought to be related to retrograde embolization of the dermal filler from peripheral vessels in the face into the ophthalmic arterial system. Early recognition and prompt management are essential if vision is to be salvaged. The use of retrobulbar hyaluronidase is still contentious, however when administered by a specialist, this treatment gives the best chance at visual recovery and should be considered for all cases.
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Affiliation(s)
- Verona E Botha
- Department of Ophthalmology, Te Whatu Ora Waikato, Hamilton, New Zealand
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Zhou LC, Dong YX, Cao MB, Li JY, Peng T, Zhang SY, Zhou YW, Shu HN, Luo SK. The Safety of Injections in the Infraorbital Region. Aesthetic Plast Surg 2024:10.1007/s00266-024-03976-5. [PMID: 38528128 DOI: 10.1007/s00266-024-03976-5] [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: 01/27/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Infraorbital filler injection is a commonly used minimally invasive cosmetic procedure on the face, which can cause vascular complications. OBJECTIVE In this study, we aimed to explore the anatomical structure of the infraorbital vasculature and to establish an accurate protocol for infraorbital filler injection. METHODS The vascular structure of the infraorbital region was evaluated in 84 hemifacial specimens using computed tomography. Four segments (P1-P4) and five sections (C1-C5) were considered. We recorded the number of identified arteries in each slice and at each location and the number of deep arteries. Furthermore, we also measured the infraorbital artery (IOA) distribution. RESULTS At P1-P4, the lowest number of arteries was detected in segment P4, with a 317/1727 (18.4%) and 65/338 (2.3%) probability of total and deep arterial identification, respectively. The probabilities of encountering an identified artery at the five designated locations (C1-C5) were 277/1727 (16%), 318/1727 (18.4%), 410/1727 (23.7%), 397/1727 (23%), and 325/1727 (18.8%), respectively. The probability of an IOA being identified at C2 was 68/84 (81%). CONCLUSION We described an effective filler injection technique in the infraorbital region to minimize the associated risks. 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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Affiliation(s)
- Ling-Cong Zhou
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Yun-Xian Dong
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Mi-Bu Cao
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Jun-Yu Li
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Tong Peng
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Si-Yi Zhang
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Yang-Wu Zhou
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Hai-Ning Shu
- Department of Plastic and Cosmetic Surgery, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guang Dong Second Provincial People's Hospital, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
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Chua AW, Chua MJ, Harrisberg BP, Kumar CM. Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review. Anaesth Intensive Care 2024; 52:82-90. [PMID: 38041616 DOI: 10.1177/0310057x231215826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.
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Affiliation(s)
- Alfred Wy Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Matthew J Chua
- Department of Anaesthetics, Liverpool Hospital, Liverpool, Australia
| | - Brian P Harrisberg
- Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Newcastle University Medical School, EduCity, Johor, Malaysia
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Borzabadi-Farahani A, Mosahebi A, Zargaran D. A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions. Aesthetic Plast Surg 2024; 48:1193-1209. [PMID: 36536092 PMCID: PMC10999391 DOI: 10.1007/s00266-022-03207-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hyaluronidase is used as an adjunct or main treatment to manage complications associated with cosmetic hyaluronic acid (HA) filler injections such as necrosis, blindness, hypersensitivity, delayed nodules, and poor aesthetic outcomes. OBJECTIVE To systematically map the available evidence and identify the gaps in knowledge on the effectiveness of hyaluronidase use in managing the aesthetic complications associated with HA injections (vascular occlusion, blindness, nodules, delayed hypersensivity, granuloma, poor aesthetic outcome). METHODS PubMed, Medline, Embase and Cochrane databases were used up to May 2022, to look for randomized clinical trials (RCTs), clinical trials, and retrospective case-control studies reporting on the use of hyaluronidase for managing the HA filler injection complications. RESULTS The database search yielded 395 studies; of those 5 RCTs (all carried out in the USA) were selected (53 subjects), indicating the effectiveness of hyaluronidase for removal of un-complicated injected HA nodules (forearm, upper arm, or back skin). The follow-ups ranged from 14 days to 4 years. The amount of HA filler injected into each site varied from 0.2 to 0.4 mL. A dose dependent response was observed for most HA fillers. No major adverse reactions were reported. Overall, for removal of every 0.1 mL of HA filler they injected 1.25-37.5 units of hyaluronidase (single injections). When 3 consecutive weekly hyaluronidase injection was used much lower doses of 0.375-2.25 unit was utilised. There was no evidence in a form of RCTs, clinical trials, and retrospective case-control studies on the removal/reversal of HA injections in the facial skin, or management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with HA filler injection. CONCLUSION Based on studies on the forearm, upper arm and back skin, hyaluronidase can be used for the reversal of uncomplicated HA filler injection nodule. However, further adequately powered studies are warranted to establish the ideal treatment protocol/dose of hyaluronidase for reversal of HA filler injections in the facial region or management of complications associated with aesthetic HA injection. LEVEL OF EVIDENCE III 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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Affiliation(s)
- Ali Borzabadi-Farahani
- Division of Surgery & Interventional Science (Minimally Invasive Aesthetics), University College London (UCL), London, WC1E 6BT, UK.
- Crouch End Orthodontics, 72 Crouch End Hill, London, N8 8AG, England, UK.
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - David Zargaran
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
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Zhao F, Chen Y, He D, You X, Xu Y. Disastrous cerebral and ocular vascular complications after cosmetic facial filler injections: a retrospective case series study. Sci Rep 2024; 14:3495. [PMID: 38347086 PMCID: PMC10861540 DOI: 10.1038/s41598-024-54202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/09/2024] [Indexed: 02/15/2024] Open
Abstract
Soft tissue filler injections are among the most popular facial rejuvenation methods. Cerebral infarction and ophthalmic artery occlusion are rare and catastrophic complications, especially when facial cosmetic fillers are injected by inexperienced doctors. Radiologists and plastic surgeons need to increase their awareness of the complications associated with fillers, which allows early diagnosis and intervention to improve patient prognosis. Regarding the mechanism by which vascular occlusion occurs after facial filler injections, a retrograde embolic mechanism is currently the predominant theory. Numerous case reports have been presented regarding complications associated with injections of facial aesthetics. However, the small sample sizes of these studies did not allow for an adequate assessment of the clinical and imaging manifestations based on the location of the occlusion and the type of filler, and detailed elaboration of multiple cerebral infarctions is also lacking. Therefore, this study aimed to investigate the clinical and radiological features of severe cerebral and ocular complications caused by cosmetic facial filler injections. In addition, we discuss the pathogenesis, treatment, and prognosis of these patients. The clinical, computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) findings were described and analysed. Radiological examinations are crucial for demonstrating severe complications, and brain MRI is especially strongly suggested for patients with cosmetic filler-induced vision loss to identify asymptomatic cerebral infarctions. Extreme caution and care should be taken during facial injections by plastic surgeons.
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Affiliation(s)
- Fanfan Zhao
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yao Chen
- Department of Radiology, 903 Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Hangzhou, Zhejiang, China
| | - Dong He
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiangxi You
- Department of Radiology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang, China
| | - Yuyun Xu
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Xiao H, Kou W, Yang Y, Dai E, Zhang X, Wen Y, Peng J, Fei P, Zhao P. Administration Method and Potential Efficacy of Hyaluronidase for Hyaluronic Acid Filler-Related Vision Loss: A Systematic Review. Aesthetic Plast Surg 2024; 48:709-718. [PMID: 36574028 DOI: 10.1007/s00266-022-03215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/19/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND With the global increase in the use of injectable fillers, more cases with serious adverse events such vision loss are being reported. This article aims to review the cases of hyaluronic acid (HA) filler-related vision loss and to discuss the potential efficacy of hyaluronidase (HYASE) treatment via different given methods. METHODS A total of 29 articles presenting 144 cases of HA filler-related vision loss were included in this study. RESULTS Most cases of HA filler-related vision impairment were reported from China, followed by Korea. The majority of cases were seen in women. The nose, forehead and glabella were the most commonly injection sites. All cases had vision impairment and nearly all cases were unilateral with immediate onset of visual signs and symptoms. Ophthalmic artery occlusion (OAO) and central retinal artery occlusion (CRAO) were the two most commonly involved arterial obstruction patterns featured with a very poor prognosis followed by branch retinal artery occlusion (BRAO), the most favorable involved arterial pattern for a better prognosis. HYASE given subcutaneously and intra-arterially helped with visual recovery to different degrees, while retrobulbar HYASE seemed to be less helpful. CONCLUSION Complications after HA-based filler injection are extremely rare but can cause disastrous visual impairment. HYASE given subcutaneously and intra-arterially helped with visual recovery to different extents, and the efficacy might be reinforced when performed together, while retrobulbar HYASE seemed to be less helpful. However, to accurately access the efficacy of HYASE via different administration methods, further randomized controlled trials are needed. LEVEL OF EVIDENCE III 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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Affiliation(s)
- Haodong Xiao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China
| | - Wei Kou
- Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuan Yang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China
| | - Erkuan Dai
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China
| | - Xuerui Zhang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China
| | - Yanjun Wen
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China
| | - Ping Fei
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China.
| | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China.
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Peng JH, Peng HLP. Treating the double chin with hyaluronic acid injection. J Cosmet Dermatol 2024; 23:79-83. [PMID: 37997546 DOI: 10.1111/jocd.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Submental fullness (SMF), or the double chin, is a condition regarded as undesirable. Many treatment modalities are available for SMF reduction, such as energy-based devices, injection lipolysis, or surgery. However, of minimal invasive modalities, hyaluronic acid (HA) injection has not been explored for possible SMF treatment. CASE REPORT A 52-year-old East Asian female patient with prominent SMF underwent HA filler injection. Aside from marked reduction of SMF prominence, an improvement of sagging over her cheeks and jawline, and a general improvement to facial aging signs was noted. CONCLUSION HA filler injections for SMF offer an instant, zero downtime, and safe alternative, and can be considered in patients who wish to simultaneously achieve improvement in other facial areas.
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Affiliation(s)
- Jui-Hui Peng
- Department of Dermatology, Hualien Tzu-Chi Hospital, Hualien, Taiwan
| | - Hsien-Li Peter Peng
- P-Skin Professional Clinic, Kaohsiung, Taiwan
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Pee XK, Low A, Ab Kahar MEPI, Mohamed SO, Chong YJ. Purtscher-like retinopathy and paracentral acute middle maculopathy following breast filler injection. BMC Ophthalmol 2023; 23:444. [PMID: 37932684 PMCID: PMC10629129 DOI: 10.1186/s12886-023-03186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To report a rare case of pulmonary and ocular complications with visual loss due to bilateral Purtscher-like retinopathy and paracentral acute middle maculopathy (PAMM) following a hyaluronic acid (HA) filler injection to the breast. Systemic and visual recovery was attained following corticosteroid therapy. CASE PRESENTATION A 27-year-old lady presented with painless blurring of vision in both eyes for 2 weeks following hyaluronic acid breast filler injections by a non-medical practitioner. She was initially admitted to the medical ward for diffuse alveolar haemorrhage and altered sensorium. The presenting visual acuity was counting fingers in both eyes. Bilateral dilated fundus examination showed hyperaemic discs, concentric rim of retinal whitening around macula with patches of polygonal-shaped retinal whitening, generalised cotton-wool spots, tortuous veins, and flame-shaped haemorrhages. Spectral-domain optical coherence tomography (SD-OCT) macula revealed hyper-reflective bands at the inner nuclear layer (INL). Fluorescein angiography demonstrated hot discs, delayed arm-to-retina time, arterial filling, and arterio-venous transit time with staining of the vessels at the posterior pole. She was managed with a tapering dose of systemic corticosteroids. The visual acuity improved to 6/12 over 8 weeks with significant anatomical and functional improvement. Dilated fundus examination showed resolution of initial funduscopy findings. The hyper-reflective bands on the OCT had resolved with subsequent thinning of the INL and disorganisation of retinal inner layers. CONCLUSION Filler injections are in increasing demand and are frequently being performed by non-medical practitioners. Visual loss from non-facial HA fillers is rare. Inadvertent entry of HA into a blood vessel may potentially cause systemic and sight-threatening ocular complications. Good anatomical knowledge and proper injection technique are vital in preventing this unfortunate sequela. There are limited reports on successful visual recovery following various treatment approaches and we hope this case provides valuable insights.
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Affiliation(s)
- Xu Kent Pee
- Department of Ophthalmology, Sarawak General Hospital, 93000, Kuching, Malaysia
| | - Adeline Low
- Department of Ophthalmology, Sarawak General Hospital, 93000, Kuching, Malaysia
| | | | - Shelina Oli Mohamed
- Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.
| | - Ying-Jiun Chong
- Department of Ophthalmology, Sarawak General Hospital, 93000, Kuching, Malaysia
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12
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Jalali A. Cocaine Nose Correction: A Nonsurgical Approach Using a Novel Hyaluronic Acid Filler. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5329. [PMID: 37817926 PMCID: PMC10561808 DOI: 10.1097/gox.0000000000005329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/24/2023] [Indexed: 10/12/2023]
Abstract
Background The use of hyaluronic acid (HA) fillers for correcting nasal deformities offers an increasingly popular alternative to surgical rhinoplasty. However, this can sometimes be extremely challenging, for example, in patients with a permanent defect in the nasal septum secondary to chronic drug use. Methods We report a case in which nonsurgical intervention with a high G' HA filler was used therapeutically to improve the permanent nasal disfigurement of an individual with previous long-term drug use (now in remission). Results This approach led to high levels of patient satisfaction and empowerment in her personal and professional life. Despite the high risk in this case, only immediate minor complications were recorded, including temporary edema and ecchymoses, and these resolved spontaneously. Conclusions Nonsurgical treatment using an appropriate HA filler may offer a safe and effective option in selected patients with nasal deformities resulting from pathological conditions.
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Affiliation(s)
- Arash Jalali
- From the University of British Columbia; and One Clinic MD, Vancouver, British Columbia, Canada
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13
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Kapoor KM, Kapoor A, Bertossi D. Role of Robotics in Neuromodulator and Filler Injections of Face. Indian J Plast Surg 2023; 56:470-473. [PMID: 38026767 PMCID: PMC10663073 DOI: 10.1055/s-0043-1775867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
In recent years, robots have been increasingly used in various fields of medicine, including surgery, dentistry, and ophthalmology. One of the newest and most promising applications of robotic technology in medicine is in the field of facial aesthetics, particularly in the injection of facial fillers and neuromodulators. While facial injections have traditionally been performed manually by trained physicians and nurses, the introduction of robots has the potential to revolutionize the field, offering a range of potential benefits, including increased precision, accuracy, and consistency of results. However, the significant disadvantages of robots are high cost, lack of flexibility and personal touch, limited experience, and risk of injury due to malfunction.
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Affiliation(s)
- Krishan Mohan Kapoor
- Anticlock Clinic, Chandigarh, India
- Department of Plastic Surgery, Fortis Hospital, Mohali, Punjab, India
| | - Aanandita Kapoor
- The Medical School, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Dario Bertossi
- Department of Maxillo-Facial Surgery, University of Verona, Verona, Italy
- Department of Maxillofacial Plastic Surgery Unit, Policlinico G.B. Rossi, Verona, Italy
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14
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Si M, Wang H. Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review. J Int Med Res 2023; 51:3000605231194514. [PMID: 37728598 PMCID: PMC10515541 DOI: 10.1177/03000605231194514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/21/2023] Open
Abstract
We describe a young woman with patent foramen ovale who developed multiple retinal artery occlusion in the right eye after injection of hyaluronic acid into the nasal root. She reported a gradual decline in visual acuity, with visual field defects that had developed in two stages. Multiple retinal artery occlusion was confirmed by slit-lamp examination, dilated fundus examination, optical coherence tomography, visual field examination, and fundus fluorescein angiography. A patent foramen ovale was detected by electrocardiography, transesophageal echocardiography, and transthoracic sonography. The patient was treated with intravenous dexamethasone and cobamamide, as well as extracorporeal counterpulsation therapy; this approach has not been described in previous literature regarding retinal artery occlusion. The patient's visual acuity improved from counting fingers at 30 cm to 20/133 within 3 days. Our report emphasizes the need for better understanding of vascular anatomy to minimize the risk of complications. Moreover, patients undergoing hyaluronic acid injection should receive information regarding the potential for mild and severe complications; relevant tests should be performed before surgery to exclude vulnerable patients. Finally, a nursing system is needed to facilitate the emergency recognition, triage, and management of retinal artery occlusion.
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Affiliation(s)
- Mingwei Si
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
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15
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Lim CS, Malhotra R. Delayed Optic Neuropathy Caused by Orbital Hyaluronic Filler Injection and Recovery Following Hyaluronidase Treatment. Ophthalmic Plast Reconstr Surg 2023; 39:e155-e158. [PMID: 37195826 DOI: 10.1097/iop.0000000000002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
A 26-year-old female presented with left enophthalmos following orbital floor and medial wall fracture despite surgical repair. She underwent further exploration and surgical repair but the enophthalmos persisted at 3-4 mm. Following discussion, she received 2 ml of hyaluronic acid filler injection into the posterior orbit and intraconal space. There were no immediate postoperative complications with normal optic nerve function, and the enophthalmos improved by 2 mm. The optic nerve function remained normal at the 4-week review. She returned 30 months following the injection with left periorbital edema, subjective red desaturation, and reduced peripheral visual field. On examination, there was a left relative afferent pupillary defect, disc pallor, and reduced visual field defect on automated visual field test. Following transcutaneous orbital injection of hyaluronidase, there was a subjective improvement in red desaturation with an improved peripheral visual field. Here the authors present a case of compressive optic neuropathy of delayed onset following orbital hyaluronic acid filler injection.
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16
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Wu WTL. Commentary on: A Computed Tomographic Investigation of the Ophthalmic Artery Volume and its Relevance to Soft Tissue Filler Injection. Aesthet Surg J 2023; 43:1033-1035. [PMID: 37248278 PMCID: PMC10435011 DOI: 10.1093/asj/sjad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Woffles T L Wu
- Corresponding Author: Dr Woffles TL Wu, 1 Orchard Boulevard, Suite 09-02, Camden Medical Centre, Singapore 248649. E-mail:
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17
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Schultz H, Dharssi S, Bacorn C, Priluck AZ, Cai S, Mahoney NR. Multiple Retinal Emboli and Medial Canthal Swelling Following Injection of Acellular Porcine Urinary Bladder Matrix for Hair Restoration. Ophthalmic Plast Reconstr Surg 2023; 39:e126-e128. [PMID: 37010050 DOI: 10.1097/iop.0000000000002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Acellular porcine urinary bladder matrix promotes wound healing and is also used to stimulate hair growth. A 64-year-old female presented with acute-onset OD pain and decreased visual acuity after subcutaneous injection of acellular porcine urinary bladder matrix at the hairline. Fundus examination revealed multiple emboli at retinal arcade branch points, and fluorescein angiography demonstrated corresponding areas of peripheral nonperfusion. Two weeks later, external examination revealed new swelling of the right medial canthus without erythema or fluctuance, which was felt to possibly represent recruitment of vessels after occlusion in the facial vasculature. At 1-month follow up, visual acuity of the OD improved with resolution of right medial canthal swelling. Fundus examination was normal with no visible emboli. Herein, the authors present a case of retinal occlusion and medial canthal swelling following injection of acellular porcine urinary bladder matrix for hair restoration, which to the authors knowledge has not been previously reported.
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Affiliation(s)
| | | | - Colin Bacorn
- Division of Oculoplastic Surgery, Department of Ophthalmology
| | | | - Sophie Cai
- Retina Division, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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18
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Alharbi MM, Bin Dlaim MS, Alqahtani JM, Alkhudhairy NS, Almasoudi SM, Alajmi NT. Ophthalmic Complications of Periorbital and Facial Aesthetic Procedures: A Literature Review. Cureus 2023; 15:e41246. [PMID: 37529817 PMCID: PMC10388289 DOI: 10.7759/cureus.41246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
The emergence and popularity of cosmetic facial procedures may lead to significant ophthalmic complications such as ocular motility dysfunction and visual disability. Here, we present a scoping review to identify common ophthalmic complications in some facial plastic surgeries and cosmetic injections, and to develop clinical approaches for prophylaxis and management in terms of direct attention and awareness of non-ophthalmologists toward such scenarios and appropriate intervention. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following keywords were used to search PubMed, Scopus, Web of Science, and Google Scholar: "facial laser", "facial fillers", "facial injections", "hyaluronic acid", "local facial injections of botulinum toxin", "rhinoplasty", "blepharoplasty blindness", "ophthalmoplegia", "diplopia", "ptosis", "ophthalmic artery occlusion", "posterior ciliary artery occlusion", and "ocular ischemic syndrome". A total of 37 articles published between 1989 and 2021 were included, of which 21 were case reports. The most common ophthalmic complication was vision loss (0.0008%). The risk of ophthalmic complications including ocular pain, sudden unilateral or bilateral vision loss, flashes of light, ptosis, and ophthalmoplegia increase with injection in common anatomical regions like the glabella, nose, and supraorbital and nasolabial folds. The incidence of adverse events ranges from 5% to 18% in rhinoplasty. The most common complications after blepharoplasty were dry eye syndrome and diplopia, caused by eyelid ptosis. Eyelid, cornea, lens, and retina injuries are ophthalmic complications that occur after facial laser treatment. Ophthalmic complications after non-ophthalmic and cosmetic procedures are becoming increasingly common. The cumulative reported cases of ophthalmic complications after hyaluronic acid filler injection from 2016 to 2020 showed different types of adverse events, with the most common being decreased visual acuity, unilateral vision loss, and ptosis, with varying outcomes of each complication ranging from partial resolution to complete recovery. These complications must be recognized early, and prompt treatment must be established.
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Affiliation(s)
- Maryam M Alharbi
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, SAU
| | - Mohammed S Bin Dlaim
- Department of Ophthalmology, King Abdullah bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, SAU
| | - Jawza M Alqahtani
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, SAU
| | - Najd S Alkhudhairy
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, SAU
| | - Shahad M Almasoudi
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, SAU
| | - Nouf T Alajmi
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, SAU
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19
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Sullivan DA, da Costa AX, Del Duca E, Doll T, Grupcheva CN, Lazreg S, Liu SH, McGee SR, Murthy R, Narang P, Ng A, Nistico S, O'Dell L, Roos J, Shen J, Markoulli M. TFOS Lifestyle: Impact of cosmetics on the ocular surface. Ocul Surf 2023; 29:77-130. [PMID: 37061220 DOI: 10.1016/j.jtos.2023.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.
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Affiliation(s)
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | | | - Sihem Lazreg
- Lazreg Cornea and Ocular Surface Center, Blida, Algeria
| | - Su-Hsun Liu
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Alison Ng
- Centre for Ocular Research & Education, School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Steven Nistico
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | | | | | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
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20
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Zhang L, Zhou Q, Xu H, Gu Q, Shi H, Pan L, Sun Y, Wu S. Long-term Prognosis of Vision Loss Caused by Facial Hyaluronic Acid Injections and the Potential Approaches to Address This Catastrophic Event. Aesthet Surg J 2023; 43:484-493. [PMID: 36495213 DOI: 10.1093/asj/sjac329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vision loss is a serious complication of hyaluronic acid (HA) filler injections, and long-term observations regarding the prognosis, particularly with angiography, are rare. OBJECTIVES This study aimed to investigate the long-term prognosis and living status of patients with visual defects due to HA filler injections. METHODS Nine patients with vision loss caused by HA filler injections and receiving different treatments were included and followed up for 2 to 6 years after their accident. Follow-ups, including outpatient ophthalmologic examinations, were performed. RESULTS In the follow-up observation, all patients had reintegrated into society and work. The prognosis was similar for all hyaluronidase treatments, including retrobulbar injections and superselective ophthalmic artery thrombolysis. The facial appearance was not remarkably affected, and only 3 patients reported slight scarring. Ptosis disappeared in all the patients, and slight strabismus was found in 5 patients. However, vision improvement was very limited, even in the patients whose occluded retinal central artery received reperfusion. CONCLUSIONS This long-term follow-up showed that the patients with vision loss caused by HA filler injections could reintegrate into society after treatment. Although the embolization of the retinal central artery led to reperfusion, vision was not restored, which further demonstrated the difficulty of recovering vision with the current treatment and the importance of prophylaxis. Autohydrolysis of HA by incorporating hyaluronidase-containing stimuli-responsive nanoparticles and a dual-pipe syringe are potential future approaches to address this catastrophic event.
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21
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Güvenç U, Ten B, Kaya Tİ, Yüksek HH, Türsen Ü. Evaluation of supratrochlear artery depth and course variations by Doppler ultrasonography along the glabellar frown lines for safer filler injections. J Cosmet Dermatol 2022; 21:6717-6726. [PMID: 36066329 DOI: 10.1111/jocd.15338] [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: 07/23/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Hyaluronic acid (HA) injection is a popular nonsurgical, rejuvenating procedure to treat glabellar frown lines, which has devastating complications such as blindness and skin necrosis due to the arterial occlusion of supratrochlear artery (STA). Therefore, when injecting into the frown lines, knowledge of the STA's depth and plane is necessary to prevent possible adverse events. The aim of this study was to identify the depths of STA in the area of the frown lines in order to maximize safety during filler injections. METHODS Supratrochlear artery depth measurements were performed at the level of eyebrow and at the level of 1.5 cm above the eyebrow. Superficial duplex Doppler ultrasonography was performed of 71 cases. RESULTS In the eyebrow level, the epidermis-artery distance (EAD) is between 1,8 and 5.9 mm, and the artery-periost distance (APD) is between 0.7 and 3.7 mm. In the 1.5 cm superior level of the eyebrow, the EAD is between 1.8 and 5.1 mm and the APD is between 0.6 and 3.8 mm. There was no significant difference between the depth measurements of the right and left STA. At the eyebrow level, APD is greater in men than in women. As the body mass index increases, the EAD and APD depth increases. EAD depth increases with increasing age. CONCLUSIONS Based on the findings of this study, safe filler injections to correct the glabellar frown lines can be possible with intradermal injections just below the ryhtide. In the glabellar region, subcutaneous and supraperiosteal injections seems to be risky.
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Affiliation(s)
- Ulaş Güvenç
- Department of Dermatology, Medical Park Mersin Hospital, Mersin, Turkey
| | - Barış Ten
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Tamer İrfan Kaya
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hasan Hüsnü Yüksek
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
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22
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Ortiz Middleton E. Evidence-based clinical guide for the management of peripheral vascular occlusion with hyaluronic acid, report of 6 successful cases. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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23
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Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2022; 46:3013-3035. [PMID: 35650299 DOI: 10.1007/s00266-022-02924-5] [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: 03/08/2022] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION With the recent increase in interest in using autologous fat (AF) filler injections to enhance aesthetic facial appearance, there is a noticeable increase in the complications such as vascular compromise and blindness. This systematic review and meta-analysis aimed to understand the symptomatology of ophthalmic complications related to AF facial injections for cosmetic purposes, their underlying causes, management options, and the final clinical outcomes. METHODS This review was conducted according to the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. In November 2021, we performed a systematic review of available literature using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Our search was limited to the published studies between 2000 and 2021. RESULTS A total of 1052 publications and 34 articles published were included. Twenty case reports, two case series, one prospective cohort study, and eleven retrospective studies were evaluated. The forehead was the most common single injection site (n = 196, 55.36%). The most common initial symptom was periorbital swelling (92.7%). The pooled prevalence of ophthalmic artery occlusion was 50.4% out of all AF injection-related complications. Regarding the management, most patients were managed conservatively (n = 278, 51.38%). Complete improvement was observed among 423 patients (80.57%). CONCLUSION Autologous facial fat injection is a minimally invasive procedure with a favorable safety profile in cosmetic applications. However, the common use of these injections in aesthetic surgery has resulted in a concomitant increase in devastating consequences, such as blindness. Therefore, a firm understanding of the potential complications of such interventions is essential. LEVEL OF EVIDENCE III 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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24
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Shen WW, Du JN, Ma JX, Xia YC, Cui LG. Evaluation of Supratrochlear, Supraorbital and Angular Artery Course Variations and Depth by Doppler Ultrasound. Aesthetic Plast Surg 2022; 47:791-798. [PMID: 36443416 DOI: 10.1007/s00266-022-03188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supratrochlear (STA), supraorbital (SOA), and dorsal nasal artery (DNA) branches from the ophthalmic artery and angular artery (AA) from the facial artery are the primary suppliers of blood to the upper face. Filler injection without precise knowledge of its vascular topography poses a risk of severe complications. METHODS Seventy-four hemifaces from 37 subjects with a median age of 25.0 (21.0, 35.0) years and a median body mass index of 21.2 (20.0, 25.4) kg/m2 underwent high-frequency ultrasound tests between March 2022 and April 2022. The bilateral location, depth, peak systolic velocity (PSV), and inner diameter (ID) of the four periorbital arteries (STA, SOA, DNA, AA) were measured. RESULTS The average ID ranges from 0.6~1.0 mm, and the average PSV ranges from 9.2~24.9 cm/s. All arteries detected passed through the superficial subcutaneous fascia. Most subjects' STAs traveled within 1.0 to 2.0 cm from the midline (left 96.8%, right 93.8%), while SOAs were mainly concentrated within 2.0 to 4.0 cm (left 83.9%, right 81.3%). STAs were more superficial and had a larger internal ID and PSV than SOAs (p<0.001). Except for the ID of the right SOA2 being significantly larger than that of the left SOA2 (p<0.05), no dominant side was found. The depth of STAs and SOAs was moderately correlated with BMI (p<0.05), except for STA1 on the left side. The course of AAs presented a high variability. CONCLUSION These findings emphasize that the periorbital arteries carry with it a likelihood of ocular complication risks during injection. Targeting the supraperiosteal layer in the STA area and the supramuscular layer in the SOA area of the inferior forehead during injection seems reasonable, and an area within 1.0~2.0 cm from the midline should be avoided. Additionally, the high variability of AAs will enhance the understanding of the anatomy of the facial artery terminals. 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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Affiliation(s)
- Wei-Wei Shen
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jia-Ning Du
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jian-Xun Ma
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China.
| | - You-Chen Xia
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, China
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de Almeida Balassiano LK, Cavallieri FA, Munhoz G, Tembra MF, Ramos-E-Silva M. NOT SO "HAPPY BUMP": A complication due to hyaluronic acid. J Cosmet Dermatol 2022; 21:6308-6313. [PMID: 35869832 DOI: 10.1111/jocd.15266] [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: 05/03/2022] [Accepted: 07/12/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The use of hyaluronic acid (HA) as a dermal filler is considered safe. However, as new brands come to the market, reports of adverse events are becoming more and more common. OBJECTIVE To describe a particular type of adverse effect that, unlike the erythematous, indurated, and painful nodules described in the literature as "angry red bumps," is characterized by noninflammatory, stony-like nodules that appear in sites previously treated with HA. METHODS The report of four patients who presented this complication, and the occurrence of two HA syringes from the same batch that had hardened the product inside at the time of filling. CONCLUSION The authors propose the nomenclature "happy bump" to group adverse reactions to HA that translate into noninflammatory nodules, with a stony consistency, appearing up to 4 weeks (recent) or after one month (late) in sites previously treated with AH.
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Affiliation(s)
- Laila Klotz de Almeida Balassiano
- Sector of Dermatology and Post Graduation Program in Medical Clinics (Area: Dermatology) - University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda A Cavallieri
- Cavallieri Clinic, Member of the Brazilian College of Radiology and Diagnostic Imaging and the National Commission of Ultrasound - Brazilian College of Radiology and Diagnostic Imaging, Rio de Janeiro, Brazil
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26
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Josipovic LN, Sattler S, Schenck TL, Sattler G. Five-point liquid rhinoplasty: Results from a retrospective analysis of a novel standardized technique and considerations on safety. J Cosmet Dermatol 2022; 21:5614-5620. [PMID: 36004561 DOI: 10.1111/jocd.15326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nonsurgical aesthetic improvement of the nose with hyaluronic acid (HA) fillers is becoming increasingly popular but comes with important safety considerations. AIMS To assess the safety and effectiveness of the standardized "five-point liquid rhinoplasty" approach. METHODS This was a retrospective, single-center analysis of consecutive adult patients undergoing nonsurgical aesthetic treatment of the nose. All had one of the three main indications (insufficient nasal projection, nasal hump, or deep glabella) and were injected using HA fillers with high elastic modulus. Treatments were given using some or all of the injection points of the "five-point liquid rhinoplasty" technique: P1 (nasal tip, 0.2-0.3 ml supracartilaginous); P2 (nasal root, 0.1-0.2 ml supraperiostal); P3 (cartilaginous dorsum, 0.1-0.2 ml supracartilaginous/supraperiostal); P4 (subnasal, 0.1-0.2 ml supraperiostal); and P5 (nasal alar, 0.1-0.2 ml per side supraperiostal). The risk of complications was minimized by injecting deep and staying in the midline as far as possible. RESULTS Twenty patients were enrolled (n = 15 female [75%]; mean age: 37.8 ± 11.7 years). The mean volume of filler used was 0.66 ± 0.35 ml per patient. Nineteen subjects (95%) said they were "very satisfied" with results, and the physician was also "very satisfied" with outcomes in 19 patients (95%). Two individuals experienced hematoma, which was managed conservatively; there were no other significant complications. CONCLUSIONS The "five-point liquid rhinoplasty" is a simple and effective method designed to maximize safety. It offers a good alternative to surgery in selected patients.
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Affiliation(s)
| | | | - Thilo L Schenck
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian Universität München, Munich, Germany
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27
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Faria GEDL, Bastos AQ, Vilela CL, Zattar L, Boggio RF. Safety of the inferolateral orbital access for filling the temporal region with the fanning technique. J Cosmet Dermatol 2022; 21:5569-5575. [PMID: 35673959 DOI: 10.1111/jocd.15146] [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: 02/14/2022] [Revised: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The anatomical complexity of the temporal region makes it so treatments with fill-ins are challenging due to high vascular risk. Techniques which provide safer procedures must be encouraged. GOAL Suggest access to the temple through the inferolateral orbital region as a means for safer temporal fill-ins. METHODS The fanning technique was plotted out not only via the conventional access (pretragal) but via the proposed one as well. The superficial temporal artery (STA) was mapped with ultrasound. The angles for each of the five retroinjection vectors were calculated in relation to STA and their mean was extracted. The longitudinality of the vector in regard to the vessel was considered the least safe factor. RESULTS The mean injection angle towards the artery was a 35-degree angle for the conventional access technique and a 73-degree angle for the inferior-lateral orbital access technique (p < 0.05). The more a degree is tangential to the vessel, the higher the chances for inadvertent puncture due to small technical issues. The safety of the procedure through the inferolateral orbital access is corroborated with blind ultrasound imaging done in real-time by radiologists. CONCLUSION The suggested access is shown to be comparably safer from a vascular perspective than the conventional pretragal access.
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Affiliation(s)
| | | | | | - Luciana Zattar
- Instituto Boggio - Medicina, ensino e pesquisa, São Paulo, Brazil
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28
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. PLASTIC AND AESTHETIC NURSING 2022; 42:238-245. [PMID: 36469395 DOI: 10.1097/psn.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones .
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm , is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Tang X, Yu Q, Guo M, Liu F, Pan Y, Zhou J, Zou Y, Wu C, Yu K, Fan M, Sun L. Multi-modal fMRI and TMS follow-up study of motor cortical stroke caused by hyaluronic acid filler: A case report. Front Neurol 2022; 13:903648. [PMID: 36158945 PMCID: PMC9492836 DOI: 10.3389/fneur.2022.903648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Blindness and stroke resulting from hyaluronic acid (HA) fillers are not frequently reported complications. Reports on stroke recovery after HA injection are limited. In the current study, the recovery process, task-based functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and neurophysiological changes of a patient with monocular blindness and ipsilateral motor cortical stroke after forehead injection of HA are explored. Case-report The study comprised a 34-year-old female patient who presented with left eye blindness and a stroke after receiving an HA injection a month before admission. The lesion was mainly limited to the left precentral gyrus, and the patient had pure arm monoparesis. For 3 weeks, the patient received conventional rehabilitation treatments and ten sessions of repetitive transcranial magnetic stimulation (rTMS) intervention. Clinical assessments, neurophysiological evaluation, task-based fMRI, and DTI examinations were conducted to assess her motor improvement and the possible neuro mechanism. Clinical rehabilitation impact The patient's right upper limb motor function was almost completely restored after receiving rehabilitation therapy. However, the vision in her left eye did not show significant improvement. The neurophysiological evaluation showed partial recovery of the ipsilesional motor evoked potentials (MEPs). DTI results showed that the ipsilesional corticospinal tract (CST) was intact. Task-based fMRI results indicated that the activation pattern of the affected hand movement was gradually restored to normal. Conclusion A case of good motor recovery after stroke due to HA injection with a lesion mainly restricted to the precentral gyrus but without CST damage is presented in the current study. Further studies should be conducted to explore the efficacy and the mechanisms of rehabilitation and neuromodulation approaches to motor cortical stroke.
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Affiliation(s)
- Xinwei Tang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiurong Yu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Miao Guo
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Fan Liu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Yongquan Pan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jingyuan Zhou
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yue Zou
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Kewei Yu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingxia Fan
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Limin Sun
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Limin Sun
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30
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Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules 2022; 27:molecules27175398. [PMID: 36080164 PMCID: PMC9458226 DOI: 10.3390/molecules27175398] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.
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31
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Wu Q, Fu Q, Xu X, Zheng C, Zhang J, Chen M. Superselective Ophthalmic Artery Thrombolytic Therapy for Hyaluronic Acid Embolization: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:1459-1463. [PMID: 35935598 PMCID: PMC9355662 DOI: 10.2147/ccid.s367481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
Abstract
Blindness caused by embolization of fillers is a rare but catastrophic complication after cosmetic injection. Vision improvement is rarely reported among the various studies on potential clinical treatments. In this case, the patient suffered from ophthalmic artery occlusion with no light perception 48 h after hyaluronic acid injection. After two intra-arterial thrombolytic therapy sessions and traditional sequential therapy, ocular appearance was restored to normal, blood supply to the retina and visual function were improved, and visual acuity was restored to hand motion levels. Our results suggest that intra-arterial thrombolytic therapy with hyaluronidase and papaverine has a positive effect on hyaluronic acid-induced visual loss and is worthy of clinical promotion.
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Affiliation(s)
- Qian Wu
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qiang Fu
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xiao Xu
- Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- Xiao Xu, Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039, People’s Republic of China, Tel +86 13381020161, Email
| | - Can Zheng
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jie Zhang
- Department of Interventional, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Minliang Chen
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- Correspondence: Minliang Chen, Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, People’s Republic of China, Tel +86 13911138381, Email
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32
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PMMA-collagen Gel in Nonsurgical Rhinoplasty Defects: A Methodological Overview and 15-year Experience. Plast Reconstr Surg Glob Open 2022; 10:e4477. [PMID: 35999875 PMCID: PMC9390807 DOI: 10.1097/gox.0000000000004477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
Nonsurgical rhinoplasty (NSR) is an alternative to surgical rhinoplasty for patients who desire correction of mild-to-moderate aesthetic nasal defects but do not wish to undergo surgery due to concern about risks, recovery time, or cost. Although not a surrogate, NSR can be a more accessible and more precise modality for achieving aesthetic goals. Furthermore, for certain types of defects, the precision possible with filler injection versus surgery can make NSR the preferred procedure. In these instances, polymethylmethacrylate (PMMA)-collagen gel is a valuable tool for appropriate candidates due to its permanence and its favorable safety profile when injected appropriately.
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Lucaciu A, Samp PF, Hattingen E, Kestner RI, Davidova P, Kohnen T, Rudolph J, Dietz A, Steinmetz H, Strzelczyk A. Sudden vision loss and neurological deficits after facial hyaluronic acid filler injection. Neurol Res Pract 2022; 4:40. [PMID: 35850779 PMCID: PMC9290300 DOI: 10.1186/s42466-022-00203-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/12/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The ongoing expansion of the cosmetic armamentarium of facial rejuvenation fails to uncover the inherent risks of cosmetic interventions. Informed consent to all risks of cosmetic filler injections and potential sequelae, including ocular and neurological complications, should be carefully ensured. We present two cases of complications following facial hyaluronic acid filler injections. CASE PRESENTATIONS Case 1: A 43-year-old woman presented with monocular vision loss of the left eye, associated ptosis, ophthalmoplegia, periocular pain and nausea, cutaneous changes of the glabella region and forehead, and sensory impairment in the left maxillary branch dermatome (V2) after receiving a hyaluronic acid (HA) filler injection into the left glabellar area. On ophthalmological examination, an ophthalmic artery occlusion (OAO) was diagnosed upon identification of a "cherry-red spot". Magnetic resonance imaging (MRI) revealed a left ischemic optic neuropathy. Supportive therapy and hyaluronidase injections were initiated. A follow-up MRI of the head performed two months after presentation corresponded to stable MRI findings. The patient had irreversible and complete vision loss of the left eye, however, the ptosis resolved. Case 2: A 29-year-old woman was admitted to hospital a few hours after a rhinoplasty and cheek augmentation with hyaluronic acid, presenting with acute monocular vision loss in the right eye, retrobulbar pain, fatigue and vomiting. In addition, the patient presented a harbinger of impending skin necrosis and a complete oculomotor nerve palsy on the right side, choroidal ischemia and vision impairment. Supportive treatment and hyaluronidase injections into the ischemic tissue were initiated. A small scar at the tip of the nose, vision impairment and an irregular pupillary margin on the right side persisted at follow-up. CONCLUSION These two case reports and the literature review emphasize the pathophysiological mechanisms leading to potentially devastating complications. In order to reduce the risk of vision loss secondary to cosmetic filler injections, practitioners should possess a thorough knowledge of anatomy and preventive strategies.
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Affiliation(s)
- Alexandra Lucaciu
- Department of Neurology, Center of Neurology and Neurosurgery, University Hospital and Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Patrick Felix Samp
- Department of Neuroradiology, University Hospital and Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital and Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Roxane-Isabelle Kestner
- Department of Neurology, Center of Neurology and Neurosurgery, University Hospital and Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Petra Davidova
- Department of Ophthalmology, University Hospital and Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, University Hospital and Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jasmin Rudolph
- Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Center of Neurology and Neurosurgery, University Hospital and Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology, Center of Neurology and Neurosurgery, University Hospital and Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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34
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Wu WTL. Commentary on: Three-Dimensional Arterial Distribution Over the Midline of the Nasal Bone. Aesthet Surg J 2022; 42:791-794. [PMID: 35439296 PMCID: PMC9208823 DOI: 10.1093/asj/sjac095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Woffles T L Wu
- Corresponding Author:Dr Woffles T. L. Wu, 1 Orchard Boulevard, Suite 09-02, Camden Medical Centre, Singapore 248649, Singapore. E-mail:
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35
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Wu Y, An HT, Hsu NJ, Loh D, Malaithong L, Park JY, Park K, Peng PHL, Sumaetheiwit R, Thammasunthorn A, Wibowo A, Liao YH. Expert recommendations on the assessment and management of complications due to hyaluronic acid soft tissue filler injections in Asians. J Cosmet Dermatol 2022; 21:3779-3786. [PMID: 35699355 DOI: 10.1111/jocd.15156] [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: 03/24/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The use of hyaluronic acid (HA) fillers for medical aesthetic purposes is increasing worldwide. Nonetheless, adverse events do occur because of patient-specific issues, injection technique, or product factors. It would be mandatory to consider cultural and anatomical features of Asians in preventing and managing the complications of HA injections. METHODS Literature search of studies looking at current evidence and guidelines on the management of complications following HA filler injections in Asian patients was conducted. This was followed by an expert group discussion that was convened to reach consensus recommendations on the best clinical practices. RESULTS The expert panel provided specific recommendations focusing on the safe use of soft tissue fillers in Asian patients, including early identification of adverse events and how to prevent and comprehensively manage these outcomes. CONCLUSIONS Here, we provide consensus statements of Asian experts in dermatology, plastic surgery, ophthalmology, and aesthetic medicine mainly focusing on AEs with higher risk for Asians and can be used to guide physicians in treating Asian population.
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Affiliation(s)
- Yan Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Hi-Tae An
- Yemiwon Aesthetic Clinic, Seoul, South Korea
| | - Nai-Jen Hsu
- Hsu Nai-Jen Dermatologic Clinic, Tainan, Taiwan
| | - David Loh
- David Loh Surgery, Singapore, Singapore
| | | | - Je-Young Park
- Apkoo-Jung Oracle Dermatology Center, Seoul, South Korea
| | - Kyungho Park
- Dream Dermatology and Laser Center, Seoul, South Korea
| | - Peter Hsien-Li Peng
- P-Skin Professional Clinic, Kaohsiung, Taiwan.,Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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36
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Yi KH, Lee JJ, Hur HW, Bae H, Kim HJ. Hyaluronic acid filler injection for deep nasolabial folds: A novel intraoral approach. Clin Anat 2022; 35:820-823. [PMID: 35665540 DOI: 10.1002/ca.23919] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022]
Abstract
Hyaluronic acid filler injection is a minimally invasive procedure for facial rejuvenation that involves injecting filling materials to correct the volume or augment specific areas in the face. Deep nasolabial folds are a common concern in aging people. The simplest way to correct a deep nasolabial fold to rejuvenate the face is to inject Ristow's space with hyaluronic acid fillers. However, conventional injection methods, such as percutaneous injections using a needle, can cause severe complications, such as skin necrosis or blindness due to intravascular injections. Therefore, the aim of the present study was to introduce a safe technique for intraoral filler injections in deep nasolabial folds and review related anatomic features to evaluate the safety of this technique.
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Affiliation(s)
- Kyu-Ho Yi
- Wonju City Public Health Center, Wonju, Kangwondo, Republic of Korea.,Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jong-Jin Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hye-Won Hur
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hyungkyu Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, South Korea.,Department of Materials Science and Engineering, College of Engineering, Yonsei University, Seoul, Republic of Korea
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37
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Ophthalmic artery occlusion after glabellar hyaluronic acid filler injection. Am J Ophthalmol Case Rep 2022; 26:101407. [PMID: 35243152 PMCID: PMC8858863 DOI: 10.1016/j.ajoc.2022.101407] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Filler injections for aesthetic purposes are very popular, but can have far-reaching and irreversible consequences. This report describes the course of a patient with devastating complications after glabellar hyaluronic acid injection, their pathomechanism, management and outcome. Observations A healthy, 43-year-old woman underwent her first hyaluronic acid injection in the glabella and went blind on her left eye immediately thereafter. Massaging of the injection area and observation were performed, before she presented with swelling of the left forehead and upper lid, ptosis, complete ophthalmoplegia and blindness in our hospital. Immediate massaging of the globe and systemic therapy including acetylsalicylic acid, tinzaparin sodium and cortisone was initiated and hyaluronidase injections in the injection area were performed. In the further course, the patient developed necrotic and hemorrhagic skin and mucosal lesions, lagophthalmos, anterior and posterior segment ischemia and globe hypotonia with consecutive globe deformation. In the follow-up of 2.5 months, lid swelling, lagophthalmos and ptosis resolved and keratopathy improved but blindness, skin lesions and strabismus with reduced eye motility were still present and madarosis and early enophthalmos were detected. Conclusions and Importance The outcome of ophthalmic artery occlusion after hyaluronic acid filler injection is poor. Sufficient knowledge about facial anatomy, the implementation of filler injections and the management of complications is essential for the practitioner. The patient should be clarified about potential and even rare risks of these procedures.
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Invited Discussion on "Comparison of Effectiveness and Safety of a Botulinum Toxin Mono Therapy and a Combination Therapy with Hyaluronic Acid Filler for Improving Glabellar Frown". Aesthetic Plast Surg 2022; 46:1881-1883. [PMID: 35608681 DOI: 10.1007/s00266-022-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
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Jitaree B, Phumyoo T. The Columellar Arteries in the Asian Nose. Facial Plast Surg Clin North Am 2022; 30:143-148. [DOI: 10.1016/j.fsc.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kern JA, Kollipara R, Hoss E, Boen M, Wu DC, Groff W, Goldman MP. Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes. Dermatol Surg 2022; 48:551-555. [PMID: 35170541 DOI: 10.1097/dss.0000000000003409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations. OBJECTIVE Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes. MATERIALS AND METHODS A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison. RESULTS Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae. CONCLUSION Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.
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Affiliation(s)
- Jessica A Kern
- University of California, San Diego School of Medicine, San Diego, California
| | | | - Elika Hoss
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Monica Boen
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Douglas C Wu
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - William Groff
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
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41
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Prétot D, Al-Sheikh M, Gunzinger J, Kahlert C. Acute Unilateral Vision Loss and Dermal Necrosis after Nose Filler Injection. Klin Monbl Augenheilkd 2022; 239:401-403. [PMID: 35472778 DOI: 10.1055/a-1785-4957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Prétot
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland.,Department of Ophthalmology, Heuberger Augenklinik AG, Olten, Switzerland
| | - Mayss Al-Sheikh
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
| | - Jeanne Gunzinger
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
| | - Christian Kahlert
- Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
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Cotofana S, Lowrey N, Frank K, Alfertshofer MG, Antezana L, Freytag L, Moellhoff N. Commentary on: Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography. Aesthet Surg J 2022; 42:535-536. [PMID: 34951452 DOI: 10.1093/asj/sjab405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Luis Antezana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lysander Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Cotofana S, Lowrey N, Frank K, Ziebart R, Guertler A, Freytag L, Helm S, Alfertshofer MG, Moellhoff N. Vascular Safe Zones for Facial Soft Tissue Filler Injections. PLASTIC AND AESTHETIC NURSING 2022; 42:80-87. [PMID: 36450087 DOI: 10.1097/psn.0000000000000430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones.
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Affiliation(s)
- Sebastian Cotofana
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicola Lowrey
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Frank
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Rachel Ziebart
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Lysander Freytag
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Sabrina Helm
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael G Alfertshofer
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Sebastian Cotofana, MD, PhD, is an associate professor of anatomy at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Nicola Lowrey, PA, is in private practice in Los Angeles, CA
- Konstantin Frank, MD, is a resident at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Rachel Ziebart, BSN, RN, is a medical student at the Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
- Anne Guertler, MD, is a medical student at the Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
- Lysander Freytag, MD, is a resident at the Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
- Sabrina Helm, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Michael G. Alfertshofer, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
- Nicholas Moellhoff, MD, is a medical student at the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
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Mortada H, Seraj H, Barasain O, Bamakhrama B, Alhindi NI, Arab K. Ocular Complications Post-Cosmetic Periocular Hyaluronic Acid Injections: A Systematic Review. Aesthetic Plast Surg 2022; 46:760-773. [PMID: 35091771 DOI: 10.1007/s00266-021-02730-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND With the global rise in the use of hyaluronic acid (HA) fillers as a minimally invasive cosmetic procedure, significant adverse effects such as vascular compromise and blindness have become common. Hence, we present the first systematic review aimed to investigate ocular complications secondary to a facial HA injection and to understand the presentation, cause, management, and outcome of these complications. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A systematic search was performed in July 2021 for published literature using the PubMed, MEDLINE, and Cochrane databases. The following terms were used: facial fillers, facial injections, hyaluronic acid, blindness, ophthalmoplegia, diplopia, ptosis, ophthalmic artery occlusion, posterior ciliary artery occlusion, and ocular ischemic syndrome. RESULTS A total of 2496 publications were searched, and 34 articles published between January 2000 and July 2021 were included. Twenty-seven case reports and seven case series were evaluated. The nose was the most common site of injection (n = 25; 40.67%). Ocular pain was the most common initial symptom of ocular complications (n = 13, 22.41 %). The most common complication was vision loss (n = 17, 50%). The majority of patients received hyaluronidase, aspirin, and steroids. Regarding the outcome, 15 (45.45%) of the published studies showed no improvement in complications even after management. CONCLUSION HA is gaining popularity in cosmetic applications. Post-HA ocular complications nearly always have an immediate onset. Proper knowledge of potential adverse events is crucial for clinicians to attempt to decrease complications and improve outcomes. LEVEL OF EVIDENCE III 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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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Hadeel Seraj
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Barasain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Basma Bamakhrama
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Khalid Arab
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Nguyen HH, Tran HTT, Duong QH, Nguyen MD, Dao HX, Le DT. Significant Vision Recovery from Filler-Induced Complete Blindness with Combined Intra-Arterial Injection of Hyaluronidase and Thrombolytic Agents. Aesthetic Plast Surg 2022; 46:907-911. [PMID: 34767060 DOI: 10.1007/s00266-021-02658-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
With the increase of cosmetic injectable hyaluronic acid (HA), there have been more cases with serious complications, including skin necrosis, blindness, and cerebral embolism. Patients who have recovered from HA filler-induced total vision loss are extremely rare. We report a case of a 27-year-old female who developed severe ocular pain on the right side and total vision loss following a 1.0 ml HA filler injection in the nasal dorsum. She arrived at our hospital 4 hours later. Her visual acuity was no light perception (NLP), and she exhibited eyelid ptosis, ophthalmoplegia, and frontal and nasal ecchymosis. She was promptly treated with subcutaneous and retrobulbar hyaluronidase injections, as well as intra-arterial 1500 IU hyaluronidase injections into the right ophthalmic artery with DSA assistance. Her vision improved from NLP to counting fingers at 1.0 meters. Unfortunately, 13 hours later, she felt an intense headache, and her vision again decreased to NLP. We immediately performed an injection of 1500 IU hyaluronidase combined with 8 mg alteplase for intra-arterial thrombolysis (IAT) into the right ophthalmic artery. Her vision improved immediately afterward. After 3 months, her visual acuity had significantly recovered from NLP (admission vision status) to 20/50 (Snellen chart with glasses). Similarly, skin, conjunctival, eye movement, and ptosis symptoms completely recovered. This case demonstrates that reversal of complete blindness due to embolism of the ophthalmic and central retinal arteries could be accomplished through multidisciplinary therapies, especially IAT using fibrinolytic agents combined with hyaluronidase followed by an anticoagulant regimen.Level of evidence VThis 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ha H Nguyen
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Vietnam.
| | - Huyen T T Tran
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Vietnam
| | - Quan H Duong
- Department of Maxillofacial - Plastic - Aesthetic Surgery, Viet-Duc University Hospital, 40 Trang Thi, Hanoi, Vietnam
| | - Minh D Nguyen
- Medical Imaging & Nuclear Medicine Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Hai X Dao
- Medical Imaging & Nuclear Medicine Center, Viet Duc University Hospital, Hanoi, Vietnam
| | - Dung T Le
- Medical Imaging & Nuclear Medicine Center, Viet Duc University Hospital, Hanoi, Vietnam
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Alfertshofer MG, Frank K, Ehrl D, Freytag DL, Moellhoff N, Gotkin RH, Mardini S, Beleznay K, Swift A, Cotofana S. The Layered Anatomy of the Nose: An Ultrasound-Based Investigation. Aesthet Surg J 2022; 42:349-357. [PMID: 34363459 DOI: 10.1093/asj/sjab310] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. OBJECTIVES The authors sought to describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. METHODS A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose utilizing ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. RESULTS In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n = 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% to 67.5% in relation to nasal length. The nasal arteries coursed superficially in 91.7% of all cases in the nasal radix, in 80% in the mid-nasal dorsum, and in 98.3% in the nasal tip. CONCLUSIONS Soft tissue filler administration in the nose carries the highest risk for irreversible vision loss compared with any other facial region. The safety of soft tissue filler rhinoplasty procedures is enhanced by knowledge of the layered anatomy of the nose, the location and depth of the major nasal vasculature, and employment of maneuvers to decrease the risk of blindness.
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Affiliation(s)
- Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - David L Freytag
- Department of Plastic Surgery, Community Hospital Havelhöhe, Berlin, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Large, star-shaped retinal tear associated with orbital cosmetic filler. Am J Ophthalmol Case Rep 2022; 25:101342. [PMID: 35243133 PMCID: PMC8859732 DOI: 10.1016/j.ajoc.2022.101342] [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: 03/11/2021] [Revised: 08/08/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Presentation of a unique case of large, star-shaped retinal tear associated with orbital cosmetic filler injection. OBSERVATION A 55-year-old healthy female presented to emergency department with sudden onset of blurred vision on her left eye occurred after an orbital cosmetic filler injection containing hyaluronic acid (HA) performed by an aesthetic nurse. On fundus examination, the left eye showed a mild - moderate, unusual appearance vitreous haze and a large, star-shaped retinal tear temporal to macula. Optical coherence tomography (OCT) examination demonstrated a normal foveal contour without any structural damage on the retinal layers. Vitrectomy, endolaser and silicon oil tamponade were performed. Visual acuity was maintained at 6/7.5 following silicon oil removal at 6 weeks after the initial surgery. CONCLUSIONS AND IMPORTANCE In this particular case, immediate vitrectomy is key to avoid further complications such as retinal toxicity and detachment and to maintain optimal visual acuity. Importantly, facial cosmetic filler procedure should be performed by an adequately trained individual to avoid such complications.
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Lazzarotto A, Robiony M, Cambiaso-Daniel J, Nocini R, Gualdi A. Social Profiloplasty:A Practical Assessment and Injection Guide. Facial Plast Surg 2022; 38:135-142. [PMID: 35253136 DOI: 10.1055/a-1789-4621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The trend of aesthetic medical procedures continues growing every year since decades all over the globe, especially considering minimal invasive treatments since the results are immediate and the downtime minimal. Hence, treatments with hyaluronic acid fillers have become extremely popular and routinely used in common practice. However, numerous areas of treatment were identified and described in the last years clinical training and consciousness of possibly complication remain still under represented. In the following article, we present four key treatment areas for optimal overall facial rejuvenation of what the authors define the social profile. Of each area an assessment, anatomical considerations, danger zones and the preferred personal technique of the authors are described.
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Affiliation(s)
| | | | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Graz University of Technology, Graz, Austria
| | - Riccardo Nocini
- 3Department of Otolaryngology, Verona City Council, Verona, Italy
| | - Alessandro Gualdi
- Division of Plastic, Aesthetic and Reconstructive Surgery, San Raffaele Hospital, Milano, Italy
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Application of Nonsurgical Modalities in Improving Facial Aging. Int J Dent 2022; 2022:8332631. [PMID: 35251183 PMCID: PMC8894069 DOI: 10.1155/2022/8332631] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Objective. This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. Overview. In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. Conclusions. Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.
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Wang HC, Yu N, Wang X, Dong R, Long X, Feng X, Li J, Wu WTL. Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review. Aesthet Surg J 2022; 42:NP162-NP175. [PMID: 33856432 PMCID: PMC8844978 DOI: 10.1093/asj/sjab193] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background With the growth in the popularity of facial filler injections, increased numbers of severe adverse events, such as cerebral embolism, have been reported. Objectives The aim of this article was to summarize the clinical manifestations and proposed mechanisms of filler-induced cerebral embolism (FICE). Methods A literature review was performed with the search keywords “filler injection,” “hyaluronic acid,” “fat graft,” “cerebral infarction,” “cerebral embolism,” “stroke,” “cerebrovascular infarction,” “disorders of consciousness,” and “hemiplegia.” Results Among the 43 cases of FICE enrolled from 35 articles, 37 patients were female, and 6 were male. Twenty-nine of these patients had received fat grafting, and 12 hyaluronic acid injection. Most FICE patients had been injected in the glabella, followed by the temporal, forehead, and nasal areas. Among 30 patients injected under local anesthesia, 43.33% presented with neurologic symptoms during the procedure. The main symptoms were consciousness disorders and hemiplegia. Most of the embolization sites were in the middle cerebral artery, followed by frontal lobe infarction and anterior cerebral artery infarction. Three patients developed cerebral hemorrhage after embolism. Twenty-six patients presented with newly acquired vision loss. The management for FICE cases included embolectomy, thrombolysis, decompressive craniectomy, antiplatelet/anticoagulant therapy, and symptomatic and nutritional treatment. Nearly half of the patients recovered or exhibited improved neurologic manifestations but not visual loss. Five patients died. Conclusions FICE is a severe complication following facial filler injection. Careful prevention, timely identification, and treatment are crucial to decreasing the morbidity and mortality of FICE. Level of Evidence: 4 ![]()
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Affiliation(s)
- Hayson Chenyu Wang
- Division of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Division of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Division of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruijia Dong
- Division of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Long
- Division of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Feng
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Jianle Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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