Background Vascular embolism is a serious complication of hyaluronic acid (HA) filler cosmetic injection and hyaluronidase injection has been proposed as the treatment. Until now there is a lack of adequate clinical evidence regarding the benefits of treatment for HA filler-induced vascular embolism by percutaneous facial or supratrochlear arterial hyaluronidase injection. Objectives To evaluate the efficacy of percutaneous facial or supratrochlear arterial hyaluronidase injection as a rescue treatment for HA filler-induced vascular embolism. Methods We included 17 patients with vascular embolism after facial HA filler injection. Intraarterial injection of 1500 units hyaluronidase was performed via facial artery for thirteen cases with skin necrosis and via supratrochlear arterial for four cases with severe ptosis and skin necrosis but no visual impairment. Simultaneously, the general symptomatic treatment and nutritional therapy were performed. Results After hyaluronidase injection, the facial skin necrosis in all cases was restored and the ptosis in the four cases was also significantly relieved. Patients were subsequently followed for 1 month to 1 year. The skin necrosis in 16 patients were completely healed and only 1 patient had small, superficial scars. Conclusions It is effective to alleviate the skin necrosis and ptosis resulting from HA filler embolism via percutaneous facial or supratrochlear arterial hyaluronidase injection.
Background Necrosis of frontotemporal skin and/or the ipsilateral scalp with subsequent alopecia after hyaluronic acid (HA) filler injection into the temple are rare and newly reported complications, with superficial temporal artery (STA) embolization suspected as the major pathological mechanism. The main treatment currently is intralesional hyaluronidase (HAase) injection, but the effectiveness of percutaneous superficial temporal arterial HAase injection still lacks consensus. Objectives The aim of this study was to investigate the effectiveness of superficial temporal arterial HAase injection in dissolving HA filler-induced necrosis of frontotemporal skin and/or the ipsilateral scalp with subsequent alopecia. Methods In this study, 5 recent clinical cases with necrosis of frontotemporal skin and/or the ipsilateral scalp with subsequent alopecia after HA filler injection into the temple were analyzed retrospectively. The patients underwent HAase injection via STA combined with adjunctive treatments, and the clinical progress was observed. Results The significant improvement was observed in terms of necrosis of frontotemporal skin and the ipsilateral scalp after treatment and the patients were relieved of their clinical symptoms. Alopecia occurred approximately 1 to 2 weeks after HA filler injection, and the well-defined alopecia areas were formed about 15 to 20 days after HAase injection. Patients were subsequently followed for 3 to 6 months. During follow-up, the skin lesions of all patients were restored to near normal appearance. Hair regrowth was observed 2 to 3 months after HAase treatment and the hair density nearly reached the normal level 3 to 4 months later. Conclusion Percutaneous superficial temporal arterial HAase injection is an effective treatment option for HA filler-induced necrosis of frontotemporal skin and/or the ipsilateral scalp with subsequent alopecia.
Blindness caused by embolization of fillers is a rare but catastrophic complication after cosmetic injection. Vision improvement is rarely reported among the various studies on potential clinical treatments. In this case, the patient suffered from ophthalmic artery occlusion with no light perception 48 h after hyaluronic acid injection. After two intra-arterial thrombolytic therapy sessions and traditional sequential therapy, ocular appearance was restored to normal, blood supply to the retina and visual function were improved, and visual acuity was restored to hand motion levels. Our results suggest that intra-arterial thrombolytic therapy with hyaluronidase and papaverine has a positive effect on hyaluronic acid-induced visual loss and is worthy of clinical promotion.
BackgroundRhinoplasty is becoming increasingly frequent as the pursuit of aesthetics by people accelerates. In recent years, the proportion of people opting for rhinoplasty injections has gradually increased. This has led to numerous reports citing catastrophic postoperative complications such as skin necrosis, cerebral infarction, and visual impairment.AimThe aim of our report is to discuss the possible etiological factors for this post‐rhinoplasty complication and provides a rationale for HA injection history as a risk factor in rhinoplasty.MethodsWe report a rare case that received nasal HA injections in the past without any untoward incident. She opted for a second rhinoplasty 2 years after her initial nasal HA injections. This second intervention led to post‐injection loss of vision in one eye and cerebral infarction. Following clinical and radiological examination, digital subtraction angiography (DSA) and superselective intra‐arterial thrombolysis were performed.ResultsThe patient did not develop disuse exotropia or ocular atrophy, but the left eye remained without light perception, which implies that intra‐arterial thrombolytic therapy may be a positive and effective method to maintain the normal appearance of the eye.ConclusionIt is advisable for patient safety to maintain a long interval of time between hyaluronidase injection and repeat rhinoplasty. Clinicians should become familiar with the anatomical peculiarities of the patient and be gentle during the rhinoplasty procedure.
Background Although micro-plasma radiofrequency (MPR) treatment has a significant effect on scars, patients require anesthesia to relieve the significant discomfort it produces. Whether anesthesia impacts efficacy is unclear. Objective To evaluate the effect of different anesthesia on MPR for hypertrophic scars. Methods A retrospective cohort study involving 101 people was conducted to investigate the effectiveness and safety of general and topical anesthetics for the treatment of MPR scars. The primary measures of outcome were the Vancouver Scar Scale (VSS) scores before the first treatment and six months after the last treatment, as well as the Visual Analogue Scale (VAS) scores on the day and the day after the final treatment. Results The differences in scar pigmentation, vascularity, and overall VSS scores were higher in the general anesthesia group than in the surface anesthesia group. Patients in the general anesthesia group had a lower pain level than those in the surface anesthesia group. After adjusting for confounding factors and propensity score matching, the outcome of VSS and VAS scores was stable. There was no statistical difference in the adverse effects and satisfaction between the two groups. Conclusion General anesthesia, as opposed to surface anesthesia, may not only ensure safety but also increase the effectiveness of MPR and lessen postoperative pain in the treatment of hypertrophic scars.
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