In some cases, it might be possible to resolve the occlusion with conservative measures, such as massage, tapping, and/or heat applied to the area. However, if conservative methods fail, hyaluronidase should be administered without delay when a hyaluronic acid dermal filler has been used.
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.
Inject with hyaluronidase.
2–5,9,10,11 When hyaluronic acid fillers are the culprit of necrosis, injecting with hyaluronidase might relieve the problem before complications even occur (Refer to the Aesthetic Complications Expert Group document on Hyaluronidase).
Sublingual aspirin 300 mg and then 75 mg/day until vascular occlusion is resolved [20,21] to prevent thrombus formation around hyaluronic acid [17,21,22]. b. Patients allergic to Aspirin can be replaced by clopidogrel 300 mg immediately and then 75 mg/day [20,21].
In most cases, mild whitening from routine vasoconstriction or anxiety improves on its own within 30 minutes after filler injections. The lips re-pink quickly with no lasting effects. We recommend icing to constrict vessels and reduce inflammation. Take Tylenol as needed for discomfort.
So, is aspirin useful for treating or preventing DVT? Well, aspirin helps prevent blood clot formation, but it doesn't break up the blood clot. This means if DVT has already occurred, it won't dissolve a blood clot that's already there. However, there is some evidence that aspirin is helpful in preventing DVT.
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.
Management and Treatment
Injecting enzymes underneath your skin to break down filler substances (hyaluronidase). Taking aspirin to thin your blood and improve blood flow. Taking antibiotics to prevent or treat infection if dead cells and tissue (necrosis) are present.
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.
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%).
The most important sign of occlusion is poor capillary return on the affected area. In comparison, a bruise will have quick capillary return. The bruising is contained in a certain location and takes on a relatively defined shape, as opposed to discoloration, spreading and a mottled appearance.
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.
Pain: A sudden, severe pain in the treated area is one of the most common signs of a vascular occlusion. The pain may be accompanied by a burning or tingling sensation.
Listed are the contents, at a minimum, included in the senior author's vascular occlusion emergency kit: hot pack(s), nitroglycerin paste. aspirin (325 mg), medrol dose pack, hyaluronidase (750 units), and a 25-gauge two-inch microcannula.
There's no cure for CRVO, but treatment can improve your vision or keep your symptoms from getting worse.
In some instances, dermal fillers can block blood vessels in the lips, leading to vascular occlusion. This can cause temporary whitening due to reduced blood flow and, in severe cases, tissue death. Such incidents require prompt medical attention. Monitor for signs like severe pain and skin color changes.
The Immediate Signs Of A Vascular Occlusion
Usually the very first indication is blanching, with the size of the blanched area varying greatly.
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 occlusions need to be treated immediately to avoid the worsening of symptoms and side-effects. If an occlusion has occurred as a result of a hyaluronic acid (HA) dermal filler and is identified in a timely manner, hyaluronidase can be injected in the affected region which helps to break down the filler.
Background: Vascular occlusion during the injection of facial fillers is uncommon, but can result in serious adverse events, including necrosis, blindness, and stroke.
Anticoagulants, such as heparin, warfarin, dabigatran, apixaban, and rivaroxaban, are medications that thin the blood and help to dissolve blood clots.
Exercise can help improve blood flow in the body, and this can be particularly helpful in preventing blood clots from forming. Regular exercise can also help in breaking down existing blood clots. Low-impact exercises such as walking, cycling, and swimming are recommended as they are less strenuous on the body.