A retrospective study of dermal fillers associated necrosis and management

Main Article Content

Lazaria Damianou
Neophytos Demetriades

Keywords

Dermal filler, hyaluronic acid, filler associated necrosis, facial aesthetics

Abstract

Background: Dermal fillers, including hyaluronic acid, play an important role in aesthetic medicine.  The immunological response is minimal, however, proper technique and pathophysiology associated with neutral and non-allergic reactions must be further studied, as adverse events might still occur leading to numerous and severe complications, such as tissue necrosis. Methods: We present a retrospective study with cases of four patients with tissue necrosis, following an aesthetic treatment for either nose correction or lip augmentation. Patients were treated from September 2019 until October 2023 in the Cyprus Facial Surgery office, at the American Medical Center located in Nicosia, Republic of Cyprus. Results: All patients had a severe reaction after 15 minutes to 48 hours following the procedure, but no permanent functional damage was reported after treatment with hyaluronidase and heparin injections. Conclusion: Mastering the injection technique of hyaluronic acid fillers, having thorough knowledge of the materials used, the timing and type of proper treatment is critical for preventing tissue ischemia and mitigating necrosis.

Abstract 31 | PDF Downloads 48

References

1. Abdul-Jabbar H. Mohammed, Basendwh A. Mohammad Complications of hyaluronic acid fillers and their managements. Journal of Dermatology & Dermatologic Surgery. 2016; 20(2):100-106.
2. Alijotas-Reig J, Fernández-Figueras MT, Puig L. Inflammatory, immune-mediated adverse reactions related to soft tissue dermal fillers. Seminars Arthritis Rheum. 2013; 43(2):241-258.
3. Burt B, Nakra T, Isaacs DK, Goldberg RA. Alar Necrosis after Facial Injection of Hyaluronic Acid. Plast Reconstr Surg. 2010; 125(5):199e-200e.
4. Chiang YZ, Pierone G, Al-Niaimi F. Dermal fillers: pathophysiology, prevention, and treatment of complications. J Eur Acad Dermatol Venereol. 2017; 31(3):405-413.
5. Cohen JL, Biesman BS, Dayan SH, et al. Treatment of Hyaluronic Acid Filler-Induced Impending Necrosis With Hyaluronidase: Consensus Recommendations. Aesthet Surg J. 2015; 35(7):844-849.
6. Kim DW, Yoon ES, Ji YH, Park SH, Lee BI, Dhong ES . Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. J Plast Reconstr Aesthet Surg. 2011; 64(12):1590–1595.
7. Doerfler L, Hanke CW. Arterial Occlusion and Necrosis Following Hyaluronic Acid Injection and a Review of the Literature. J Drugs Dermatol. 2019; 18(6):587-591.
8. Galadari H, Krompouzos G, Kassir M, et al. Complication of Soft Tissue Fillers: Prevention and Management Review. J Drugs Dermatol. 2020; 19(9):829-832.
9. Loghem J, Funt D, Pavicic T, et al. Managing intravascular complications following treatment with calcium hydroxylapatite: An expert consensus. J Cosmet Dermatol. 2020; 19(11):2845-2858.
10. Souza Felix Bravo B, Klotz De Almeida Balassiano L, Roos Mariano Da Rocha C, et al. Delayed-type Necrosis after Soft-tissue Augmentation with Hyaluronic Acid. J Clin Aesthet Dermatol. 2015; 8(12):42-7.
11. Tracy L, Ridgway J, Nelson JS, Lowe N, Wong B. Calcium hydroxylapatite associated soft tissue necrosis: a case report and treatment guideline. J Plast Reconstr Aesthet Surg. 2014; 67(4):564-8.