Filler Migration to the Orbit

Abstract Background Dermal filler injections continue to grow in popularity as a method of facial rejuvenation. This increase in the number of injections performed has resulted in an increasing number of types of filler-related complications. Objectives We report a series of cases where dermal filler injected in the face migrated to the orbit. Treatment methods and possible mechanisms of this newly reported complication are discussed. Methods A retrospective, multicenter analysis was performed on patients with dermal filler migration to the orbit after facial filler injections. Results Seven patients (6 females, 1 male; age range, 42-67 years) presented with orbital symptoms after filler injection and were subsequently found to have dermal filler in the orbit. Four out of 7 patients underwent orbitotomy surgery, 1 patient underwent lacrimal surgery, 1 patient had strabismus surgery, and 1 patient was treated with hyalurodinase injections. All patients have remained stable postoperatively. Conclusions Orbital complications secondary to migrated filler may occur long after the initial procedure. Because the site of the complication is distant from the injection site, patients and physicians may not immediately make the connection. Furthermore, this may lead to unnecessary examinations and a delay in diagnosis while looking for standard orbital masses. Dermal fillers should therefore be considered in the differential diagnosis of patients presenting with new-onset orbital masses. Level of Evidence: 4

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Surgical outcomes of strabismus after iatrogenic ophthalmic artery occlusion caused by cosmetic filler injections

BMC Ophthalmology ◽

10.1186/s12886-019-1264-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Hee Kyung Yang ◽

Se Joon Woo ◽

Seong-Joon Kim ◽

Jeong-Min Hwang

Keyword(s):

Surgical Outcomes ◽

Ophthalmic Artery ◽

Artery Occlusion ◽

Strabismus Surgery ◽

Successful Outcome ◽

Ocular Motility ◽

Hand Motion ◽

Filler Injection ◽

Facial Filler ◽

Filler Injections

Abstract Background To investigate the surgical outcomes of strabismus related to iatrogenic occlusion of the ophthalmic artery and its branches from cosmetic facial filler injection. Methods A retrospective study was performed on 6 patients who underwent strabismus surgery among 23 patients who had suffered occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection. Initial, preoperative and final ocular motility examinations, the type of surgery and surgical outcomes were evaluated. Results At initial presentation, visual acuity was no light perception in 5 patients and hand motion in one patient. Five out of 6 patients showed initial ophthalmoplegia. Among these 5 patients, eye motility fully recovered in 3 patients although sensory strabismus developed during follow-up, while the remaining 2 patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2 ± 1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, 5 of the 6 patients showed exotropia, and one patient had esotropia. Vertical deviation was found in 3 out of 6 patients in addition to the horizontal deviation. Successful outcome was achieved only in the 4 patients without persistent ophthalmoplegia after 1.4 ± 1.0 years from surgery. The other two patients with persistent ocular motility limitations failed to achieve successful alignment after surgery, and one patient eventually underwent evisceration due to phthisis bulbi. Conclusions In our study, surgical outcomes of strabismus caused by cosmetic facial filler injection were successful only in patients without persistent ophthalmoplegia at the time of surgery.

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452 Dermal Filler Injection Leading to Facial Cellulitis: A Case Report

British Journal of Surgery ◽

10.1093/bjs/znab259.614 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

E Baldock ◽

C Devine ◽

A Holden ◽

S Colbert

Keyword(s):

Hospital Admission ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

Dermal Filler ◽

Filler Injection ◽

Facial Filler ◽

Intravenous Antibiotics ◽

Filler Injections ◽

Aesthetic Procedure ◽

Dermal Filler Injection

Abstract Background Aesthetic medicine is a rapidly expanding field that is progressively becoming a normal part of society’s health and beauty regime. Hyaluronic Acid dermal filler injections are the second most widely performed aesthetic procedure, following Botulinum Toxin type A. Although serious complications are rare, they can have a detrimental impact on aesthetic outcome and general health. Infections following dermal fillers can be difficult to treat and have the potential to require hospital admission, intravenous antibiotics and surgical intervention. Case description We present a case of a 41-year-old female who suffered from facial cellulitis as a consequence of palpebro-malar groove dermal filler injections. The patient had 0.1ml of Monalisa dermal filler injected over her right malar prominence and suffered complications 6 days later, which eventually lead to the need for hospital admission on day 12 following the procedure for intravenous antibiotics. The management of this aesthetic procedure complication is outlined to highlight the risks and serious complications of these procedures. Conclusions Facial cellulitis is a rare adverse event following facial filler injection; however, it is an important risk factor to discuss during the consent process for these procedures. In addition, it is important that a highly trained and skilled professional performs these injections using a sterile non-touch technique due to the potential for serious complications and the anatomical proximity to vital structures.

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HA Filler Injection and Skin Quality–Literature Minireview and Injection Techniques

Indian Journal of Plastic Surgery ◽

10.1055/s-0040-1715545 ◽

2020 ◽

Vol 53 (02) ◽

pp. 198-206

Author(s):

Jui-Hui Peng ◽

Peter Hsien-Li Peng

Keyword(s):

Volume Loss ◽

Quality Change ◽

Facial Aging ◽

Filler Injection ◽

Quality Literature ◽

The Face ◽

Filler Injections ◽

Injection Techniques ◽

Injection Protocol ◽

Skin Quality

AbstractAging of the face produces many changes in the structure and integrity of the skin and other anatomical aspects, the three major signs of which are volume loss, sagginess, and skin quality change. Through surgical or nonsurgical procedures, it is possible to slow or even reverse these mechanisms through artificial means, including thread lifting, radiofrequency, or filler injection. Filler injections are particularly popular in recent years, owing to their convenience, efficacy, and long-lasting results. In this minireview, the author outlines the basic mechanisms behind facial aging, discusses current literature on each aspect of facial aging, and offers injection protocol recommendations based on past literature and clinical experience.

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Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjab193 ◽

2021 ◽

Author(s):

Hayson Chenyu Wang ◽

Nanze Yu ◽

Xiaojun Wang ◽

Ruijia Dong ◽

Xiao Long ◽

...

Keyword(s):

Literature Review ◽

Cerebral Artery ◽

Vision Loss ◽

Clinical Manifestations ◽

Fat Grafting ◽

Cerebral Embolism ◽

Fat Graft ◽

Filler Injection ◽

Facial Filler ◽

Filler Injections

Abstract Background With the popularity of facial filler injections, increased severe adverse events, such as cerebral embolism, have been reported. Objectives This article aims to summarize the clinical manifestations, and proposed mechanism of the filler-induced cerebral embolism (FICE) cases. Methods A literature review was performed with the search keywords including “filler injection, hyaluronic acid, fat graft, cerebral infarction/embolism, stroke, cerebrovascular infarction, disorders of consciousness, and hemiplegia”. Results Among the 43 cases of FICE from 35 articles enrolled, 37 patients were female, and 6 were male. Twenty-nine of these patients received fat grafting, followed by 12 who received HA injection. Most of the injection sites of FICE patients were at the glabella, followed by temporal, forehead, and nasal areas. Among 30 patients receiving injection under local anesthesia, 43.33% presented with neurological 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, and 17 patients did not have 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 improved in neurological manifestations but not the visual loss. Five patients died. Conclusions FICE is a severe complication following facial filler injection. Careful prevention, timely identification and treatment are crucial to decrease the morbidity and mortality of FICE.

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

Aesthetic Surgery Journal ◽

10.1093/asj/sjz312 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1009-1021 ◽

Cited By ~ 5

Author(s):

Greg J Goodman ◽

Mark R Magnusson ◽

Peter Callan ◽

Stefania Roberts ◽

Sarah Hart ◽

...

Keyword(s):

Hyaluronic Acid ◽

Best Practice ◽

Visual Loss ◽

Adverse Reactions ◽

Level Of Evidence ◽

Early Management ◽

Initial Management ◽

Filler Injection ◽

Filler Injections ◽

Review Current

Abstract Background Hyaluronic acid fillers have a satisfactory safety profile. However, adverse reactions do occur, and rarely intravascular injection may lead to blindness. Currently there is no internationally recognized consensus on the prevention or management of blindness from hyaluronic acid filler. Objectives The authors sought to give guidance on how to minimize the risk and optimize the management of this rare but catastrophic adverse reaction. Methods A multinational group of experts in cosmetic injectables from multiple disciplines convened to review current best practice and develop updated consensus recommendations for prevention and bedside intervention if visual loss occurs after cosmetic injection of hyaluronic acid filler. Results The consensus group provided specific recommendations focusing on the consenting process, prevention, and early management of visual impairment related to intravascular hyaluronic acid filler injection. Conclusions Although visual loss due to filler injections is rare, it is important that both patient and physician be aware of this risk. In this paper the authors describe methods and techniques available to reduce the risk and also document suggested initial management should a clinician find themselves in this situation. Level of Evidence: 5

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Asymptomatic Stroke After Hyaluronic Acid Filler Injection: Case Report and Literature Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa381 ◽

2020 ◽

Author(s):

Ryan M Moore ◽

Melissa A Mueller ◽

Allison C Hu ◽

Gregory R D Evans

Keyword(s):

Hyaluronic Acid ◽

Vision Loss ◽

Facial Soft Tissue ◽

Tissue Ischemia ◽

Filler Injection ◽

Intraarterial Injection ◽

Facial Filler ◽

Vascular Compromise ◽

Filler Injections ◽

Soft Tissue Filler

Abstract Vascular compromise and blindness are reported but rare complications of facial soft tissue filler injections. Stroke is an even rarer complication resulting from intraarterial injection of fillers. We present a case of a patient suffering all three complications following hyaluronic acid filler injection: forehead skin vascular compromise, unilateral blindness, and ipsilateral subclinical strokes. Were it not for a stroke workup protocol, the incidental strokes may have otherwise gone undetected, suggesting the incidence of stroke from intraarterial injection may be higher than reported. Further, we review the literature and recommendations for prevention and management of threatened tissue ischemia and vision loss from facial filler injection.

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Quality and Reliability of YouTube for Patient Information on Facial Fillers

The American Journal of Cosmetic Surgery ◽

10.1177/0748806821991408 ◽

2021 ◽

pp. 074880682199140

Author(s):

Manish J. Patel ◽

Mit M. Patel ◽

Brittany T. Abud ◽

Robert T. Cristel

Keyword(s):

Patient Education ◽

Patient Experience ◽

Average Length ◽

Dermal Filler ◽

Accurate Information ◽

Sufficient Information ◽

Inclusion Criteria ◽

Educational Value ◽

Facial Filler ◽

Source Reliability

YouTube proves to be a source of health information for patients. This is the first study to analyze the source reliability and educational value of YouTube videos on facial filler treatments. On August 12, 2020, YouTube.com was queried using the keywords “facial filler” or “dermal filler” or “fillers.” A total of 100 were initially reviewed in which 74 videos met the inclusion criteria and were included in the final analysis. Video characteristics were recorded, and each video was graded for source reliability and educational value by using the Journal of the American Medical Association (JAMA) benchmark criteria and the Global Quality Score (GQS), respectively. Furthermore, each video was assessed to determine whether there was discussion of 5 different topics that were deemed to be useful to patients prior to undergoing a facial filler treatment. A total of 74 videos met the inclusion criteria and had an average length of 436 seconds (7 minutes and 16 seconds), 146 805 views, 1906 likes, 73 dislikes, and 241 comments. Forty-five videos (61%) were posted with an intention to educate patients, whereas 29 videos (39%) were posted with an intention to describe a patient’s experience with facial filler treatment. Patient education videos were found to have a significantly higher educational value ( PGQS < .001). Patient experience videos showed no difference in reliability score ( PJAMA > .05) to patient education videos, but patient experience videos were found to have lower educational value compared with patient education videos ( PGQS < .001). In addition, both categories are not providing sufficient information for informed decision-making prior to treatment deemed by the 5 selected categories we found most informative. As patients will continue to seek educational material online, clinicians should use this information to help primarily educate patients with standardized and accurate information about their treatment.

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Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

European Journal of Plastic Surgery ◽

10.1007/s00238-021-01855-9 ◽

2021 ◽

Author(s):

Renata Migliardi ◽

Alessandra Modugno ◽

Fabrizio Chirico ◽

Nicola Zerbinati ◽

Giovanni Francesco Nicoletti ◽

...

Keyword(s):

Hyaluronic Acid ◽

Case Series ◽

Outpatient Setting ◽

Level Of Evidence ◽

Upper Eyelid ◽

Filler Injection ◽

Tear Trough Deformity ◽

Vasovagal Response ◽

Superior Sulcus ◽

Therapeutic Study

Abstract Background One of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry. Methods Thirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed. Results No complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection. Conclusions Hyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome. Level of evidence: Level IV, therapeutic study.

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