Blanching following injections is usually the result of vasoconstriction. As flow of blood to the vessels is constricted, the localised skin turns pale or white. This presentation is known as blanching or skin blanching.
In most cases, mild whitening from routine vasoconstriction or anxiety improves on its own within 30 minutes after filler injections.
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.
In this case, necrosis often turns the skin blue or gives it a blue cast. It can also result in pustules and a scaly look along with white plaques. Sometimes the affected skin turns black. The necrosis is not only difficult to look at but also quite painful.
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.
If you experience any signs of an allergic reaction after a filler injection, such as tenderness, swelling or asymmetrical fullness, seek medical attention immediately. Ask your doctor to test for allergies to the injectable fillers and/or the liquid gel in which they are suspended.
The skin may look pale at first but quickly becomes red or bronze and warm to the touch and swollen. Pain is intense. Later, the skin turns violet, often with the development of large fluid-filled blisters (bullae). The fluid from these blisters is brown, watery, and sometimes foul smelling.
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.
White Blanching refers to instances where the skin looks noticeably paler or whiter than its surrounding area often due to reduced blood flow. This change in color typically indicates a diminished blood flow to that specific section of the skin, often causing it to feel cool upon touch.
Vascular occlusion is one of the rare complications of dermal filler treatment. It may happen as early as receiving the injectable filler or as late as 24 hours post-treatment. When left untreated, this condition can lead to more serious complications, like blindness, necrosis, and stroke.
These reactions, occurring months after injection, can include swelling, inflammation, and infections. The research highlights the importance of patient selection, high-quality products, and strict hygiene to minimize risks, providing valuable guidelines for practitioners to ensure safer aesthetic treatments.
The area should go white; remove the pressure and the area should return to red, pink or darkened color within a few seconds, indicating good blood flow. If the area stays white, then blood flow has been impaired and damage has begun.
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).
MRSA may look like a bump on the skin that may be red, swollen, warm to the touch, painful, filled with pus, or draining. The pus or drainage contains the infectious bacteria that can be spread to others.
Discoloration:Necrotic tissue often appears darker or discolored, ranging from pale white or yellowish (slough) to dark brown or black (eschar). Slough may be adherent to the wound bed or nonadherent. Eschar is typically well adhered to the wound bed.
Purulent drainage refers to thick, milky discharge that comes out of a wound. It usually means you have infection, so it's important to get prompt medical care. Treatment can prevent cellulitis (skin infection), osteomyelitis (bone infection) and other serious conditions like sepsis.
Late complications are defined as those appearing after about 2-6 weeks. They comprise late allergic reactions, chronic inflammation and infection, granulomas, filler migration, loss of function, telangiectasia, and hypertrophic scars. A detailed history may disclose a potential allergy.
“Pillow face” occurs when too much filler is injected into areas like the cheeks, nasolabial folds (the lines from your nose to the corners of your mouth), lips, and under-eye area. This repeated overfilling can result in a bloated, round appearance that looks far from natural.
Diagnosing dermal filler infections:
The patient will present with a combination of lump, redness, tenderness, swelling or pus.
How do you identify blanching following toxin injections? The skin around the injection site(s) will generally turn much paler than your patient's normal skin tone. Often the skin turns completely white, especially in Caucasian patients.
We are presenting this case report because of its uniqueness in the fact that most of the intra-arterial occlusions and signs of ischemic skin necrosis occur immediately or within few hours of the filler injection going intravascular.