Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials

Area of Science:

• Dermatology
• Plastic Surgery
• Vascular Medicine

Background:

• Facial antiaging treatments using dermal fillers carry risks of ischemic events.
• Ischemia from fillers can result in severe outcomes, including Nicolau syndrome, blindness, and stroke.
• Understanding facial vascular anatomy is crucial for safe filler injections.

Purpose of the Study:

• To outline methods for preventing ischemic complications associated with facial dermal filler treatments.
• To provide guidance on managing dermatologic emergencies arising from filler-induced ischemia.
• To emphasize the importance of anatomical knowledge and specific injection techniques.

Main Methods:

• Review of anatomical landmarks and vascular pathways in the face.
• Discussion of preferred procedural techniques, such as cannula use and retrograde injection.
• Description of immediate management protocols for detected ischemia, including hyaluronidase injection.
• Guidelines for handling ocular ischemia, recommending hospital transfer for stroke code activation.

Main Results:

• Cannula use and retrograde injection are preferred techniques to minimize vascular occlusion risk.
• Early detection and prompt injection of hyaluronidase are key to managing skin ischemia.
• Ocular ischemia requires immediate specialized medical intervention, including stroke protocol activation.

Conclusions:

• Preventing ischemic events involves a deep understanding of facial anatomy and employing safer injection techniques.
• Prompt recognition and treatment of ischemia are critical to mitigate severe complications.
• Adherence to emergency protocols ensures optimal patient outcomes following filler-related ischemic events.