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Review
. 2024 Jul 18;14(14):1555.
doi: 10.3390/diagnostics14141555.

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication

Gi-Woong Hong  1 , Hyewon Hu  2 , Kathleen Chang  3 , Youngjin Park  4 , Kar Wai Alvin Lee  5 , Lisa Kwin Wah Chan  5 , Kyu-Ho Yi  2   6
Affiliations
Review

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication

Gi-Woong Hong et al. Diagnostics (Basel). .

Abstract

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

Keywords: blindness; cannulas; dermal fillers; hyaluronic acid; hyperbaric oxygen therapy; injection techniques; ischemia; pulmonary embolism; tissue necrosis; vascular complications.

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Conflict of interest statement

I acknowledge that I have considered the conflict of interest statement included in the “Author Guidelines”. I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to significantly affect my views on the subject I am presenting.

Figures

Figure 1
Figure 1
Ischemic state with purple skin of reticular pattern.
Figure 2
Figure 2
Infection state with pustule formation.
Figure 3
Figure 3
Wound healing state with eschar formation.
Figure 4
Figure 4
Entry point where central retinal artery goes through the optic nerve.
Figure 5
Figure 5
The pathway of the optic nerve and relationship with other anatomical structures. The rights for the figure belong to the authors.
Figure 6
Figure 6
Aspiration test for highly elastic biphasic HA filler using needle.
Figure 7
Figure 7
Aspiration test for highly elastic biphasic HA filler using medium-sized cannula.
Figure 8
Figure 8
Aspiration test for highly elastic biphasic HA filler using large-sized cannula.
Figure 9
Figure 9
Aspiration test for medium elastic biphasic HA filler using needle.
Figure 10
Figure 10
Aspiration test for medium elastic biphasic HA filler using small-sized cannula.
Figure 11
Figure 11
Aspiration test for medium elastic biphasic HA filler using medium-sized cannula.
Figure 12
Figure 12
Aspiration test for monophasic HA filler using needle.
Figure 13
Figure 13
Aspiration test for monophasic HA filler using small-sized cannula.
Figure 14
Figure 14
Biodegradable microspheres, like the porous-structured PDLLA (Juvelook, VAIM Inc., Seoul, Republic of Korea), gradually break down over time, minimizing long-term risks.
See this image and copyright information in PMC

References

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