Failed facemask ventilation in a patient with recent dermal filler injections

The rising popularity of facial cosmetic procedures presents new challenges for peri-operative anaesthetic care. We report a case of failed facemask ventilation in a woman with recent dermal filler injections to her cheeks and chin and without any well-described predictors of a difficult airway. After pre-oxygenation and induction of anaesthesia, attempts at facemask ventilation failed to achieve an effective seal as the augmented areas were unusually firm and unyielding, preventing proper mask fit. Despite head optimisation and chin lift, insertion of an oropharyngeal airway and the use of a two-person technique effective ventilation could not be achieved. Early insertion of a second-generation supraglottic airway device restored ventilation and allowed surgery to proceed safely. This case illustrates how dermal fillers can alter facial compliance, obscure anatomical predictors of difficulty, and even be mistaken for allergic swelling. Anaesthetists are encouraged to ask specifically about cosmetic procedures, use inclusive language to promote disclosure and adapt airway plans accordingly.