Delayed skin necrosis following hyaluronic acid filler injection: A case report

Most popular fillers in cosmetic medicine are hyaluronic acid based. These comprise over 90% of the market and come with the advantage to be soluble in case of complications. Other fillers are contained in the group of bio-stimulatory fillers. They exert a secondary volumizing effect by provoking a low-grade inflammatory response that produces extra collagen. Examples are calcium-hydroxyapatite and L-poly-lactid acid. Finally autologous fat is being used as a filling substance (lipofilling). The gravest complications with fillers are intravascular injections. In particular when injected in arteries fillers can block blood flow and lead to skin necrosis or vison loss in case the material occludes the Central Retinal Artery (CRAO). Two opposing theories about the nature of arterial occlusion exist. One based on Ian Taylor idea of choke anastomoses assume vasoconstriction induced by the filler, both of the primary offended artery and its anastomosing vasosomes. In this case resolving the hyaluronic acid filler with the enzyme hyaluronidase at the primary occluding location would suffice. This is done under ultrasound guidance. The other theory assumes displacement of parts of the filler to end arterioles. Then, the whole affected area has to be flooded with large dosages of hyaluronidase. Obstructions with fillers based on other materials cannot be resolved. It seems logical to prevent intra-arterial filler injection by duplex sonography detection of the course of arteries prior to injection. Ultrasound has additional advantages for cosmetic doctors such as recognizing remains of previously injected filler. It also can give feedback on a physician’s ability to inject filler in the correct subdermal location.

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The Risk of Skin Necrosis Following Hyaluronic Acid Filler Injection in Patients With a History of Cosmetic Rhinoplasty

Aesthetic Surgery Journal ◽

10.1093/asj/sjy005 ◽

2018 ◽

Vol 38 (8) ◽

pp. 883-888 ◽

Cited By ~ 18

Author(s):

Reza M Robati ◽

Fatemeh Moeineddin ◽

Mina Almasi-Nasrabadi

Keyword(s):

Hyaluronic Acid ◽

Skin Necrosis ◽

Filler Injection ◽

History Of ◽

Cosmetic Rhinoplasty

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Hyaluronic Acid Injections as Nonsurgical Alternative in case of Delayed Diagnosis of Malar Arch Fracture: Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2019/1360741 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Raffaele Rauso ◽

Giorgio Lo Giudice ◽

Nicola Zerbinati ◽

Gianpaolo Tartaro

Keyword(s):

Hyaluronic Acid ◽

Case Report ◽

Functional Impairment ◽

Delayed Diagnosis ◽

Facial Trauma ◽

Facial Fracture ◽

Filler Injection ◽

First Case ◽

Filler Injections ◽

Fracture Diagnosis

Background. In this article, we describe a nonsurgical approach based on hyaluronic acid filler injection to restore the facial features of a delayed diagnosis of malar fracture. We analyze the differences between surgical and nonsurgical solution: in case of early detection, the surgical approach is the gold standard of treatment. However, in cases of delayed facial fracture diagnosis without functional impairment, nonsurgical procedures could be considered an alternative tool as we show in the present case report. Aims. The aim of this study is to underline the importance of a complete aesthetic restoration in patients treated for noncosmetic purposes. Patients/Methods. We present a case of a 26-year-old male patient with a delayed diagnosis of malar fracture without functional impairment that was treated with hyaluronic acid (HA) filler injections. Results. The patient was followed up for 1 year showing stable results for the first 8 months; at the 12-month follow-up, a touch-up was suggested due to partial resorption of the filler. Conclusion. This is the first case describing a facial fracture treated with HA injections for only recontouring purposes. We assess that nonsurgical cosmetic procedures could be considered a “new” tool in the process of facial rehabilitation but only when functional problems are not associated with facial trauma.

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The Risk of Skin Necrosis Following Hyaluronic Acid Filler Injection in Patients with a History of Cosmetic Rhinoplasty

Aesthetic Surgery Journal ◽

10.1093/asjour/sjy005 ◽

2018 ◽

Author(s):

Reza M Robati ◽

Fatemeh Moeineddin ◽

Mina Almasi-Nasrabadi

Keyword(s):

Hyaluronic Acid ◽

Skin Necrosis ◽

Filler Injection ◽

History Of ◽

Cosmetic Rhinoplasty

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HYALURONIC ACID FILLER INJECTION FOR COSMETIC PURPOSE: SKIN NECROSIS COMPLICATION AND TREATMENT - CASES REPORTS

Tạp chí Y học Việt Nam ◽

10.51298/vmj.v506i1-2.970 ◽

2021 ◽

Vol 506 (1-2) ◽

Author(s):

Vu Ngoc Lam ◽

Nguyen Quang Duc ◽

Le Diep Linh ◽

Le Thi Thu Hai

Keyword(s):

Wound Healing ◽

Hyaluronic Acid ◽

Skin Necrosis ◽

Early Recognition ◽

Complete Healing ◽

Soft Tissue Augmentation ◽

Filler Materials ◽

Dermal Fillers ◽

Filler Injection ◽

Specific Protocol

Background: Hyaluronic acid (HA) fillers for aesthetic are generally considered safe and the use of dermal fillers for soft tissue augmentation has become a very popular technique in aesthetic practices. Dermal fillers temporarily remove the appearance of rhytids and reduce the depth of skin folds. This is one of the most effective method for facial improvement used in Viet Nam nowadays. However, complications such as skin necrosis, blind... may happen and hence any filler injection practitioner need to be aware of such side effects, contraindications and precaution to be adopted while using fillers. Even with the most experienced of injectors, adverse effects can and do occur ranging from mild bruising to severe injection necrosis. Aims: HA filler injectors should be able to prevent and treat the severe complication of skin necrosis and detect impending necrosis after injection of a augmentation filler. Materials and Methods: Cases report of 3 patients who were HA filler injection for nose augmentation and had suffered from skin necrosis. These patients were followed for 3-6 months from time of injection of hyaluronic acid filler to complete healing of wound. Results: Complete wound healing were achieved with early recognition and institution of treatment, surgical procedures applied in some severe cases. The functional of the noses are remained but most of the patients have bad scar on the nose. Discussion: We review cases report of injection necrosis and methods used to prevent and treat this complication. Conclusion: Early recognition of vascular necrosis with specific protocol for treatment after injection necrosis with hyaluronic acid fillers improves the outcome of wound healing.

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