The backflow of substances from the injection area into the internal carotid artery and small facial arteries occurs due to pressure and the vascular network, leading to complications such as ocular and cerebral infarction, skin ischaemia and necrosis7 (Fig.
However, as previously discussed, when the tip of the needle penetrates the artery and pressure is applied to the plunger, the filler can reverse the flow in it, moving as a column proximal to the origin of the retinal artery.
Bruising may occur if an artery or blood vessel has become blocked due to filler injection. Bruising may range from a blue discoloration to a dusky purple-grey appearance. Swelling is likely to occur in and around the injection site if vascular obstruction is present, and may range from mild to severe.
Accidental intra-arterial filler injection may cause significant tissue injury and necrosis.
If you have a vascular occlusion after a dermal filler, you could experience symptoms 12 to 24 hours after your filler procedure. Vascular occlusion is a serious condition that needs medical treatment immediately.
Early signs of vascular occlusion include pain, pale skin or white blanching after filler and prolonged capillary refill. These symptoms are commonly seen within minutes to an hour of an occlusion occurring. Later signs of an occlusion are perishingly cold skin and purple mottling or livedo reticularis.
How do you reduce the severity of a vascular occlusion? This is largely about reducing the amount of filler that gets injected into the wrong place during treatment. Separating out the volumes as you inject, into small aliquots at a time allows you time to validate that there is no VO in between each injection.
Hit vein if deep/dark red blood enters syringe. Hit nerve if no blood enters syringe. Can lead to infection, abscess, paralysis, and loss of limb. Hit artery if bright red, foamy blood enters or spurts out.
Vascular complications occur as result of inadvertent arterial injection of filler material and could result in serious injury in the form of cutaneous necrosis, blindness, or stroke.
As with any medical procedure, there are risks involved with the use of dermal fillers. Most side effects associated with dermal fillers, such as swelling and bruising occur shortly after injection and many resolve in a few days to weeks. In some cases, side effects may emerge weeks, months, or years later.
Filler Danger Zones
Glabellar region (just above the nose and between the eyebrows) Temporal fossa (area around the temples bordered by the outer eye socket, upper cheekbone, hairline, and forehead)
Common danger zones include the glabellar region, temporal fossa, infraorbital region, perioral region, lips, oral commissure, nasal area, and areas with major arteries like the supratrochlear, supraorbital, infraorbital foramen, mental foramen, facial artery, and deep temporal arteries.
It isn't a common occurrence and if treated by a skilled, medical practitioner, the risk of migration is very small. Though it can happen in any area of your face, filler migration is most noticeable on thinner areas of skin, like under your eyes or on the upper lip.
The symptoms of ischemia can occur immediately after the injection or several hours after the procedure. Here, the authors report three cases of necrosis after hyaluronic acid injection with the first symptoms presenting only several hours after the procedure.
Vascular occlusion warning signs (2): pallor
After the initial injection, the next sign of a problem with a VO is usually pallor. In the case of a true, complete vascular occlusion, pallor is very stark, particularly in lips. There will be a grey patch on the lip that sometimes has zero capillary refill.
Delivery of certain medications via arterial access has led to clinically important sequelae, including paresthesias, severe pain, motor dysfunction, compartment syndrome, gangrene, and limb loss.
Complications of entering the artery with a large cannula intended for venous cannulation can result in complications such as temporary occlusion, pseudoaneurysm and haematoma formation. [6] Unrecognized arterial injection of anaesthetic drugs can cause tissue ischaemia and necrosis.
You always want to inject into a vein and never into an artery. Veins are blood vessels that carry blood from the extremities of the body back to the heart and lungs where it becomes re-oxygenated. Veins have no pulse, and the blood they carry is a deep, dark red because it is low in oxygen.
The onset of symptoms of vascular occlusion from dermal filler treatment can vary depending on the case, but it can show up immediately after receiving the facial filler injection or as late as 24 hours.
Minor complications
This is particularly common if the filler is not injected deep enough into the skin. They might possibly cause a bluish colour due to a phenomenon called the Tyndall effect, and this is often clearly evident in the area just beneath the eyes. This discolouration can last for years.