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

Abstract

Recently, there is a growing interest of hyperbaric oxygen therapy in many fields of medicine. We had a 43-year-old female patient presented with severe necrosis of the nose, philtrum, and upper lip due to retrograde arterial occlusion after nasolabial fold hyaluronic acid filler injection. Our patient went through 43 sessions of systemic hyperbaric oxygen therapy from December 2, 2017 to January 18, 2018. We administered 2.8 atmosphere absolute (ATA) for 135 minutes in the first session and the remaining sessions consisted of 2.0 ATA for 110 minutes. In reporting this case, we wish to provide a warning regarding the latent risk of filler injections and share our experience about minimizing soft tissue damage in the early stages with systemic hyperbaric oxygen therapy.

Evaluation and management of facial granuloma caused by various injection materials

“…In the field of plastic surgery, various surgical procedures involve the injection of medical fillers with proven safety, including collagen or hyaluronic acid preparations [ 8 , 9 ]. Moreover, in the case of foreign body granulomas caused by medical filler injection, in addition to surgical resection, treatments using various approaches such as hyaluronic acid degrading enzyme injection, local or systemic steroid therapy, or treatment with bleomycin have been introduced [ 9 , 10 ].…”

The Role of Hyperbaric Oxygen in Head and Neck Reconstruction and Facial Cosmetic Surgery

“…Vascular occlusion is the most feared complication, which may result in skin necrosis, vision loss, or stroke. [40][41][42] This occurs following accidental injection and/or embolization of the filler material into the arterial system. Standard treatments for ischemic injury following fillers include warm compresses, hyaluronidase, corticosteroids, topical nitroglycerin, phosphodiesterase inhibitors, aspirin, and low molecular weight heparin.…”

“…41 HBO has been successfully used in the treatment of complications following filler injections; however, descriptions of its use are largely limited to case reports. 40,43,44 As previously discussed, HBO has several mechanisms that would be valuable in treating postfiller ischemia. HBO increases the oxygenation of compromised tissue, improves angiogenesis, reduces edema, minimizes reperfusion injury, and may help combat infection.…”

“…While there is no consensus protocol for the dosing, frequency, or duration of HBO treatments in the management of complications following cosmetic procedures, it is recom-mended that HBO be initiated as soon as the complication is identified and continued until clinical improvement is observed. 40 It is unlikely that HBO alone could lead to complete functional and cosmetic recovery. Specifically, HBO may reduce the severity and progression of tissue necrosis and promote functional recovery.…”

“…Surgical intervention with serial debridement of nonviable tissue may be necessary in addition to HBO. 40…”