Central Forehead Ischemic Skin Injury following Glabellar Botulinum: A Paradigm Microshift?

Abstract

Vascular occlusion events have surged in incidence due to the increased popularity of cosmetic injectables. Ostensibly, treatments that involve nonparticulate solutions, such as botulinum, have traditionally been thought to carry no risk of vaso-occlusive complications. In this article, we report the first published instance of a suspected ischemic skin injury after botulinum injection to the glabella and surmise on the potential etiological mechanisms that may underlie these rare occurrences.

“Needle micro-cores: can they pose an occlusive threat with non-particulate injections?”

“…1,2 Notwithstanding the well-described intravascular risk of filler-borne arterial blockade, the more enigmatic reports of vascular occlusion arising from injections of nonparticulate solutions, such as botulinum, present a puzzling etiology that suggests additional mechanisms of injury. 3 One such potential cause involves the incidental capture and ejection of tissue microcores (1 to 1000 μm) by hypodermic needles during routine cosmetic dermal injections. 4,5 To test this hypothesis, we investigated the occurrence of incidental needle microcoring with 31-G tuberculin needles through a cytologic analysis of needle-captured tissue samples.…”