The best strategy for prevention is avoiding the “danger zones,” especially in the glabellar, forehead, and upper nasal labial fold areas. If vision loss is suspected, the client must make an emergency visit to an ophthalmolo- gist.
Accidental intra-arterial filler injection may cause significant tissue injury and necrosis.
Infraorbital Foramen (Nasolabial)
Injecting above the infraorbital foramen, i.e., superficially, in the fatty tissue is considered safer. To safely inject in this area, consider marking out your patient so you can establish your known anatomy and then you can avoid the area of the infraorbital foramen.
A proper calculation on the risk of vascular occlusion has, to our knowledge, never been performed because odds are low and total numbers of injections are generally unknown. In medical literature, frequencies of vascular adverse events (VAEs) are not detailed but estimated to be 1:2000 to 1:10,000 (0.05–0.01%).
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.
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.
The most common dermal filler danger zones are the following: 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) Infraorbital region (malar cheek fat pad, located right under the eye sockets)
Evidence dictates that there are two main areas on the face that have a higher incidence of vascular occlusion following soft tissue augmentation with filler: the glabellar region and the nasolabial fold, nasal tip, and alar triangle.
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.
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.
The arteries of the face are thin. If larger volumes of filler is injected into one of them it can travel quite a distance, sometimes to the artery that supplies oxygen to the retina in the back of the eye. And if it does reach the back of the eye it is only a few more millimetres to the brain.
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.
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.
Background: Vascular occlusion during the injection of facial fillers is uncommon, but can result in serious adverse events, including necrosis, blindness, and stroke.
In the lower two-thirds of the nasolabial fold, injections into the deep dermal and superficial subcutaneous plane are generally safe because most of the facial artery course lies beneath muscle and/or above it but in deeper planes; however, in the upper one-third, the artery can become very superficial.
The other chin fillers including PMMA, Polylactic acid and Calcium hydroxylapatite are not reversible – they cannot be removed.
The most popular technique is retrograde linear threads which are created when the filler is injected whilst withdrawing the needle. Linear techniques are quite precise. This is key, for example, if augmenting the vermillion border and lip body or superficial dermal lines with crosslinked skin boosters.
There's no wrong or right age to start your dermal filler journey, as long as you're a healthy adult of course. Many men and women in their 60s and beyond can benefit from dermal fillers, especially ones like Sculptra that stimulate your collagen for improvement in your skin at its core.
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.
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.
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.