Hyperbaric Oxygen for Ischemia due to Injection of Cosmetic Fillers: Case Report and Issues

Abstract

Summary:Natural and synthetic fillers have revolutionized aesthetic facial rejuvenation and soft-tissue augmentation. We present a case highlighting the dangers of filler self-injection. A 37-year-old woman self-injected a dermal filler around both temples. She immediately experienced left--side hearing loss, blanching over the left face, and pain. Prompt treatment with hyaluronidase, topical nitro paste, and warm compresses ensued. An emergency computed tomography angiogram showed occlusion of a superficial temporal artery branch. We treated her with enoxaparin, aspirin, dexamethasone, piperacillin-tazobactam, and intradermal lidocaine. After 6 hyperbaric oxygen therapy (HBO2) treatments in 3 days, the patient showed improvement in appearance with markedly decreased ischemic discoloration and her hearing returned to baseline. Algorithms for treating such injuries generally neglect HBO2. HBO2 is thought to be efficacious in these situations by a variety of mechanisms: oxygenation of ischemic tissues, reduction of edema, amelioration of ischemic/reperfusion injury, promotion of angiogenesis and collagen maturation. Her resolved hearing highlights the utility of HBO2 in sudden hearing loss as well. Injectors should have guidelines for using product, not only on patients but staff as well. Filler courses should include handling complications and include HBO2 in their guidelines. Clinicians should remind patients to seek treatment from qualified clinicians. The goal of a bargain price using self-injection may quickly become expensive and disfiguring.

Minimizing tissue damage due to filler injection with systemic hyperbaric oxygen therapy

“…Nowadays, increasing the oxygen content with HBOT for wound management has been gaining interest worldwide and is reported as a useful tool for treating vascular compromise [4]. However, only a few cases with the potential to raise interest in HBOT have been reported so far [11]. The primary effect of HBOT is hyper-oxygenation increasing diffusion length and depth of oxygen through the tissues, thus resulting in anti-ischemic effect.…”

Vascular Complication in Aesthetic Medicine Treated with Hyperbaric Oxygenation

“…In such an event it is required to interrupt the procedure and immediately administer hyaluronidase for the purpose of dissolving the hyaluronic acid [1,2,3,4,5]. If ulceration occurs, it is necessary to apply hyperbaric oxygenation [6].…”

Another face of dermal fillers

“…The recommended scheme of this therapy consists of 6 total treatments, performed twice daily, the initial 2 at 3.0 atm absolute for 90 min followed by 4 treatments at 2.4 atm for 90 min, all with air breaks every 30 min. The first cycle should be begun within 15 h after the initial injection [ 28 ]. If necrosis has occurred, it is important to minimize scarring by providing careful wound care with daily dressings.…”