Localization and Staging of Vascular Adverse Events After Facial Fillers: A Detailed Assessment

Area of Science:

• Dermatology and Aesthetic Medicine
• Vascular Surgery
• Facial Anatomy

Background:

• Vascular adverse events (VAEs) are a significant concern after dermal filler injections.
• Clinical observation suggests a lower risk of VAE-associated necrosis in the lateral facial region compared to the medial region.

Purpose of the Study:

• To statistically determine if the medial facial region exhibits a higher risk of necrosis following dermal filler injections compared to the lateral facial region.
• To analyze the correlation between VAEs and facial arterial supply patterns.

Main Methods:

• Retrospective analysis of 120 VAE cases reported between 2019 and 2024.
• Anatomical subdivision of the face using three methods: primary arteries, carotid artery branches, and medial/lateral regions.
• Classification of VAEs into five stages, distinguishing non-necrotic (Stages 1-2) and necrotic (Stages 3-5) outcomes.

Main Results:

• Necrotic VAEs (Stages 3-5) were significantly more frequent in the medial facial region (P = .048).
• No significant correlation was found between necrotic VAEs and the distribution of primary facial arteries or carotid artery branches.

Conclusions:

• The medial facial region presents a higher risk of necrosis after dermal filler treatment compared to the lateral region.
• The absence of correlation with major arterial distributions suggests local vascular factors, such as anastomoses, play a key role in VAE necrosis.