Avoiding the “Danger Zones” When Injecting Dermal Fillers and Volume Enhancers

Brennan, Connie

doi:10.1097/psn.0000000000000053

Cited by 29 publications

(26 citation statements)

References 9 publications

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“…Dermal filler injection has become accepted worldwide as a minimally invasive procedure for regaining a younger appearance and improving the facial features. Glabellar augmentation a popular cosmetic procedure for correcting excessive depression of the nasal bridge; however, this correction is considered one of the most dangerous procedures compared to injections at other areas of the face such as lip, cheek, and chin (Brennan, ; Beleznay et al, ; Scheuer 3rd et al, ; Wu et al, ; Tansatit et al, ). Various injection techniques are deployed with different injection planes and sites depending on the physicians' experience (Bass, ; Sykes et al, ; Sattler and Gout, ).…”

Section: Introductionmentioning

confidence: 99%

Anatomical and Ultrasonography‐Based Investigation to Localize the Arteries on the Central Forehead Region During the Glabellar Augmentation Procedure

et al. 2019

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Glabellar augmentation is one of the most popular cosmetic procedures but can entail severe complications caused by inadvertent intravascular injection of filler. Nevertheless, few studies have investigated the arteries on the glabellar and central forehead regions. The aim of this study was to correlate the topography and location of the arteries in this area with anatomical landmarks to propose a safety guideline. Two methods were used to investigate the glabellar and central forehead areas: dissection of 19 Thai embalmed cadavers, and ultrasonographic examination of 14 healthy Thai volunteers. At the level of the glabellar point, the horizontal distances from the midline to the arteries were 4.7 mm (central artery), 7.8 mm (paracentral artery), and 14.7 and 19.2 mm (superficial and deep branches of supratrochlear artery). The depths from the skin of the arteries were 3.1 mm (central artery), 4.8 mm (paracentral artery), and 4.2 and 5.9 mm (superficial and deep branches of supratrochlear artery). The periosteal artery was detected in 71.1% as a branch of either the superior orbitoglabellar or the supratrochlear artery. It ran in the supraperiosteal layer for a short course and penetrated the periosteum above the superciliary ridge or above the medial eyebrow, adhering tightly to the bony surface. This study suggests a safe injection technique for the glabella based on a thorough knowledge of arterial distribution and topography and color Doppler ultrasonographic examination prior to the injection, which is recommended to minimize the risk of severe complications. Clin. Anat. 33:370–382, 2020. © 2019 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Anatomical and Ultrasonography‐Based Investigation to Localize the Arteries on the Central Forehead Region During the Glabellar Augmentation Procedure

et al. 2019

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“…It can be considered an emergency and must be recognized and treated immediately [6], in order to minimize permanent damages.…”

Section: Introductionmentioning

confidence: 99%

“…The rare cases of visual impairment and blindness [4], after injection in this region can be possible because of the retrograde fl ow of intravascular injected material into the ophthalmic artery or into one of the distal branches that supply the retina and cornea. Cerebral ischemic events may also occur [3][4][5][6][7][8][9][10]. if the fi ller emboli reach the internal carotid artery and then propel into the intracranial circulation.…”

Section: Introductionmentioning

confidence: 99%

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Ischemical Problems after Filler Injections: Anatomical Details and Practical Guide Lines to Avoid Disasters

Alessio¹,

Melania²,

Ivanov³

2017

Arch Anat Physiol

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Introduction: Soft-tissue fi ller injection is a very common procedure all around the world. Although the safety profi le for these products is favorable, adverse events can occur, ranging from mild to severe in intensity. The most disastrous complication reported is accidental intra-arterial fi ller injection or in rare case due to the compression of the vessel associated with tissue injury and necrosis. Objectives:The authors performed a literature search to identify the facial sites most prone to severe complications, especially due to anatomical structure. After a review of these complications they discuss preventive measures in order to avoid ischemical problems after fi ller injections and try to give a prompt intervention guidelines to manage this kind of complication and signifi cantly decrease the risk of long term sequelae. Method:The National Library of Medicine, the Cochrane Library, and Ovid MEDLINE were searched, and relevant articles were retrieved based on specifi c criteria. The complications reviewed included softtissue necrosis, fi ller embolization and visual impairment.Results: Data collected from these case reports showed that the most common injection sites for necrosis are the glabella, the nose and the nasolabial fold. Blindness was most often associated with injection of the glabella. A thorough understanding of the facial vascular anatomy and a good injection technique reduce the risk of vascular occlusion. Conclusions:Although soft-tissue fi llers are a popular choice for minimally invasive rejuvenation of the face, physicians should be aware of the serious potential ischemical adverse event risks by using a correct technique of injection based on a good knowledge of anatomy and good instruments trying to prevent and/or manage its.

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“…In some cases, permanent materials such as silicone and polymethylmethacrylates are also used [6-8]. …”

Section: Introductionmentioning

confidence: 99%

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

et al. 2019

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Objective: Dermal fillers are an important tool in the field of aesthetic dermatology. Fillers are relatively noninvasive and easy to use but are not free of secondary complications. The main complications are vascular and are due to either the compression of an artery or the direct introduction of the product into the arterial lumen. The aim of this study is to provide an overview of the vascular territories of the face to avoid many possible complications when using facial fillings. Anatomical localization of the main arterial supply to the face has been described to assess the risk of vascular injury. Methods: The authors dissected 17 hemifaces of embalmed adult cadavers that had previously been injected, through the common carotid artery, with latex containing a red dye. Results: A topographic distribution was generated by facial regions following a clinical approach from where the facial fillings were placed and related to the pathways of the arteries. Following these criteria, we established 8 topographic regions (I–VIII) that indicate the main vascular problems of each of these regions. Detailed anatomical localizations of the main arteries in these topographic regions of the face and their relationships are described. Conclusions: The highest index of vascular lesions and especially visual alterations occurred for fillings of the upper third of the face. To prevent and avoid this type of lesion, it is advisable to avoid, as much as possible, treatments with filling materials in the upper third of the face, mainly including the glabellar and nasal region (III) and supraorbital region (VIII).

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Avoiding the “Danger Zones” When Injecting Dermal Fillers and Volume Enhancers

Cited by 29 publications

References 9 publications

Anatomical and Ultrasonography‐Based Investigation to Localize the Arteries on the Central Forehead Region During the Glabellar Augmentation Procedure

Anatomical and Ultrasonography‐Based Investigation to Localize the Arteries on the Central Forehead Region During the Glabellar Augmentation Procedure

Ischemical Problems after Filler Injections: Anatomical Details and Practical Guide Lines to Avoid Disasters

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

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