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Song D, Wang X, Yu Z. Nonsurgical Rhinoplasty: An Updated Systematic Review of Technique, Outcomes, Complications, and Its Treatments. Aesthetic Plast Surg 2024:10.1007/s00266-024-04161-4. [PMID: 38862661 DOI: 10.1007/s00266-024-04161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND For patients looking for temporary results or who do not want surgery, nonsurgical rhinoplasty using filler injections has become increasingly popular. Filler materials and surgical techniques have improved in recent years, but serious complications remain. Therefore, the aim of this systematic review is to summarize the common types of fillers and injection techniques, complications, and treatment to help clinicians perform in a safer and more effective way. METHODS A systematic review was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and the Cochrane Library were searched using the appropriate search terms. Data collected from each study included injection materials, location, technique, patient satisfaction and complications, and treatment. RESULTS From the 1812 studies identified, 30 were included in the systematic review. A total of 9657 patients underwent nonsurgical rhinoplasty, most commonly with hyaluronic acid (HA) (96.76%), followed by calcium hydroxyapatite (CaHA) (1.22%). Overall satisfaction was 99.08%. The overall incidence of complications was 39.11%, with the highest incidence of erythema and swelling (27.95%). Most of the complications are mild, but there are still 0.27% of the patients who have undergone severe complication-an arterial occlusion. CONCLUSIONS Nonsurgical rhinoplasty is an effective and relatively safe option for improving the profile of the nose, with a short operative time and high patient satisfaction. Most of the complications were mild, but still serious vascular complications such as blindness, skin necrosis, and stroke were as high as 0.27%. A thorough understanding of the anatomy of the nasal vessels and a precise surgical technique is an important basis for prevention. A BULLET POINT LIST: (1) We summarize the common types of fillers and injection techniques, complications, and treatment of complications to guide physicians to perform nonsurgical rhinoplasty in a safer and more effective manner. (2) Out of 1812 studies through the search strategy, 30 articles were included in the systematic review. A total of 9657 patients underwent nonsurgical rhinoplasty. (3) Nonsurgical rhinoplasty is an effective and relatively safe option to improve the profile of the nose, with a short surgical time and high patient satisfaction. (4) Most of the complications were mild, but some severe complications due to the vascular factors such as blindness, skin necrosis, and cerebral infarction need to be vigilant. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Dandan Song
- Department of Plastic and Aesthetic(Burn) Surgery, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, Hunan, People's Republic of China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic(Burn) Surgery, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, Hunan, People's Republic of China.
| | - Zidi Yu
- Department of Plastic and Aesthetic(Burn) Surgery, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, Hunan, People's Republic of China
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He F, Luo X, Meng F, Chen J, Liang C, Zhang Y, Liu S, Yuan Z, Zhang W, He Y, Zhang J. Subcutaneous injection of hyaluronic acid leading to emboliom and recanalization process monitored in real time by three-dimensional photoacoustic imaging. Heliyon 2024; 10:e25066. [PMID: 38314292 PMCID: PMC10837626 DOI: 10.1016/j.heliyon.2024.e25066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024] Open
Abstract
This study describes a method for real-time examination of the microvascular system based on the three-dimensional photoacoustic imaging system to prevent arterial complications, especially vascular embolism, during hyaluronic acid (HA) injections. Chicken embryos were used to simulate the superficial blood vessels of human skin, and then the target area was imaged by the photoacoustic imaging system for three-dimensional vascular imaging, and then the syringe and blood vessels were monitored, and the syringe angle and penetration depth were adjusted in time using an injection device to avoid puncturing the arterial vasculature and clogging the blood vessels. HA was then injected into smaller vessels on the dorsum of the tongue in mice and into thicker vessels on the dorsal portion of the tongue in rats to mimic embolization, and the post-operative recovery was reflected by the changes in the pixel dots of the extracted part of the blocked blood vessels, and it was observed that the blood flow in the area of the fine vessels was restored in about 3 days, whereas blood flow in the area of the large vessels was restored in only about 1 h. The method presented in this paper allows precise guidance of injectable filler HA, which has good application prospects in improving the safety of injection micro-plastic surgery and reducing the experience requirements for medical personnel.
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Affiliation(s)
- Fengbing He
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Xingzhi Luo
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Fan Meng
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Jiarui Chen
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Chaohao Liang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Yiqing Zhang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Shutong Liu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Zishan Yuan
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Wuyu Zhang
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Yanping He
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Jian Zhang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
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Zhuang J, Zheng Q, Su X, Jiang L, Hu J. Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5225. [PMID: 37650096 PMCID: PMC10465098 DOI: 10.1097/gox.0000000000005225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023]
Abstract
Background Embolism is a serious complication after facial filling, with a usually poor prognosis of the symptoms after embolism. The authors systematically reviewed reported cases of facial vascular embolism, explored the relationship between the location and material used for facial filling and occurrence of vascular embolism, and assessed the prognosis of complications after vascular embolism. Methods This study provides a systematic review of published cases of vascular embolism after facial filling. A summary of the filling materials and filling sites for each case, the adverse reactions and embolized blood vessels, a recording of the time when each patient experienced adverse reactions and started treatment, and a presentation of their prognosis are provided. Results The frontal, eyebrow, and nose are common filling sites causing facial embolism. The main clinical manifestations after embolism were visual impairment, skin necrosis, and ptosis. The prognosis of visual impairment after embolization was poor, whereas skin necrosis and ptosis generally improved after treatment. Conclusions This article aimed to review the clinical manifestations, therapies, and prognosis of embolism after facial filling. A better understanding of these complications can help clinicians to detect the occurrence of complications as early as possible and give patients timely treatment.
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Affiliation(s)
- Jun Zhuang
- From the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, Xuhui District, Shanghai, China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liya Jiang
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jintian Hu
- From the Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Si S, Su W, Wang L, Ji Y, Chen A, Hu Y. A novel predictive model for phthisis bulbi following facial hyaluronic acid cosmetic injection. BMC Ophthalmol 2023; 23:244. [PMID: 37259051 DOI: 10.1186/s12886-023-02992-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To observe long-term prognosis of anterior segment ischemia (ASI) following hyaluronic acid (HA) injection, propose a severity grading system for ASI and a predictive model for phthisis bulbi (PB) based on long-term secretion dysfunction of ciliary process. METHODS This is a retrospective case-control study. All enrolled 20 patients were divided into two groups and followed for at least 6 months to observe the formation and transformation characteristics of ASI and long-term prognosis based on the degrees of ciliary function damage. RESULTS The severity of ASI following HA injection could be subdivided into 4 grades according to the degrees of ciliary function damage, comprising ASI grades 0, 1, 2 and 3. In 20 patients, ophthalmoplegia at 1-month follow-up, ASI within 1 month, ASI at 1-month follow-up, hypotony within 6 months were all significantly more common in study group than in control group (60% vs. 0%, P = 0.011; 100% vs. 20%, P = 0.001; 100% vs. 0%, P < 0.001; 80% vs. 0%, P = 0.001, respectively). Sensitivity, specificity and the area under the receiver operating characteristic curve (AUC) for predicting subsequent PB at 2-year follow-up through the co-occurrence of ophthalmoplegia at 1-month follow-up and hypotony within 6 months was 100%, 100% and 1.00, respectively. CONCLUSIONS The new grading system for ASI and novel predictive model for PB we proposed could predict the long-term prognosis and probability of subsequent PB due to ASI following HA injection through several dynamic assessments within 6 months. LEVEL OF EVIDENCE Level IV, observational prognostic study.
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Affiliation(s)
- Shancheng Si
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Wei Su
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Lei Wang
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yicong Ji
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Anming Chen
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yuntao Hu
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
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Asensio-Sánchez VM. Central retinal artery occlusion following facial injection of hyaluronic acid. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00082-8. [PMID: 37247664 DOI: 10.1016/j.oftale.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 05/31/2023]
Abstract
A 57-year-old woman with no premorbidities presented with symptoms of sudden painless vision loss in the right eye (RE). Best-corrected visual acuity in the RE was counting fingers to. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of central retinal artery occlusion. Systemic evaluation was normal. The most interesting fact in this case is that a hemorrhagic edema in the right glabellar region was the basis for the diagnostic suspicion. The patient recognized the loss of vision 24 hours after hyaluronic acid injection as a facial rejuvenation treatment.
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Affiliation(s)
- V M Asensio-Sánchez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain.
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Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2022; 46:3013-3035. [PMID: 35650299 DOI: 10.1007/s00266-022-02924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION With the recent increase in interest in using autologous fat (AF) filler injections to enhance aesthetic facial appearance, there is a noticeable increase in the complications such as vascular compromise and blindness. This systematic review and meta-analysis aimed to understand the symptomatology of ophthalmic complications related to AF facial injections for cosmetic purposes, their underlying causes, management options, and the final clinical outcomes. METHODS This review was conducted according to the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. In November 2021, we performed a systematic review of available literature using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Our search was limited to the published studies between 2000 and 2021. RESULTS A total of 1052 publications and 34 articles published were included. Twenty case reports, two case series, one prospective cohort study, and eleven retrospective studies were evaluated. The forehead was the most common single injection site (n = 196, 55.36%). The most common initial symptom was periorbital swelling (92.7%). The pooled prevalence of ophthalmic artery occlusion was 50.4% out of all AF injection-related complications. Regarding the management, most patients were managed conservatively (n = 278, 51.38%). Complete improvement was observed among 423 patients (80.57%). CONCLUSION Autologous facial fat injection is a minimally invasive procedure with a favorable safety profile in cosmetic applications. However, the common use of these injections in aesthetic surgery has resulted in a concomitant increase in devastating consequences, such as blindness. Therefore, a firm understanding of the potential complications of such interventions is essential. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Navarro-Hernandez E, Pérez-López M. Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:521-538. [PMID: 35787383 DOI: 10.1016/j.oftale.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Blindness after periocular cosmetic filler injection is a rare but devastating complication. Complication management protocols recommend injecting retrobulbar hyaluronidase if visual loss related to accidental intravascular injection of hyaluronic acid occurs. Given the dramatic increase in cosmetic filler injections and the variety of professionals that can deliver them, it is reasonable to assume that the incidence of complications will rise significantly. OBJECTIVE To evaluate if there is evidence-based efficacy of retrobulbar hyaluronidase injection in visual loss secondary to periocular cosmetic filler injection. MATERIAL AND METHODS The authors performed a search of English and Spanish language articles following the PRISMA statement published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series and experimental investigations. We identified a total of 13 patients in this review following defined inclusion and exclusion criteria. Finally, we included 15 articles in the study, 12 of them were cases / case series. The 2 remaining articles are experimental studies in animals with a control group, in which after causing selective occlusion of the ophthalmic artery, serial injections of retroocular hyaluronidase are administered with control of visual function. RESULTS Of the 15 articles included in the study, we studied 17 patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness. Improvement was demonstrated in 3 cases. Animal studies demonstrate variable data are provided regarding the recovery of visual acuity. CONCLUSIONS There is no confirmed evidence of retrobulbar hyaluronidase injection effectiveness in treating visual loss due to accidental intravascular injection of hyaluronic acid. More studies are needed to show the efficacy of hyaluronidase as a treatment for blindness caused by hyaluronic acid.
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Affiliation(s)
| | - M Pérez-López
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, Spain
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Keyhan SO, Ramezanzade S, Yazdi RG, Valipour MA, Fallahi HR, Shakiba M, Aeinehvand M. Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis. Maxillofac Plast Reconstr Surg 2022; 44:17. [PMID: 35451637 PMCID: PMC9033909 DOI: 10.1186/s40902-022-00344-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/18/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials. MATERIALS AND METHODS After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis. RESULT Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively. CONCLUSION The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57). TRIAL REGISTRATION This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644 ).
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Affiliation(s)
- Seied Omid Keyhan
- Present Address: Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Shaqayeq Ramezanzade
- Present Address: Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | - Reza Golvardi Yazdi
- Present Address: Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
| | | | - Hamid Reza Fallahi
- DDS,OMFS Founder & Director, Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Ahvaz, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Aeinehvand
- Present Address: Maxillofacial Surgery & Implantology & Biomaterial Research Foundation, Tehran, Iran
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Mortada H, Seraj H, Barasain O, Bamakhrama B, Alhindi NI, Arab K. Ocular Complications Post-Cosmetic Periocular Hyaluronic Acid Injections: A Systematic Review. Aesthetic Plast Surg 2022; 46:760-773. [PMID: 35091771 DOI: 10.1007/s00266-021-02730-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND With the global rise in the use of hyaluronic acid (HA) fillers as a minimally invasive cosmetic procedure, significant adverse effects such as vascular compromise and blindness have become common. Hence, we present the first systematic review aimed to investigate ocular complications secondary to a facial HA injection and to understand the presentation, cause, management, and outcome of these complications. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A systematic search was performed in July 2021 for published literature using the PubMed, MEDLINE, and Cochrane databases. The following terms were used: facial fillers, facial injections, hyaluronic acid, blindness, ophthalmoplegia, diplopia, ptosis, ophthalmic artery occlusion, posterior ciliary artery occlusion, and ocular ischemic syndrome. RESULTS A total of 2496 publications were searched, and 34 articles published between January 2000 and July 2021 were included. Twenty-seven case reports and seven case series were evaluated. The nose was the most common site of injection (n = 25; 40.67%). Ocular pain was the most common initial symptom of ocular complications (n = 13, 22.41 %). The most common complication was vision loss (n = 17, 50%). The majority of patients received hyaluronidase, aspirin, and steroids. Regarding the outcome, 15 (45.45%) of the published studies showed no improvement in complications even after management. CONCLUSION HA is gaining popularity in cosmetic applications. Post-HA ocular complications nearly always have an immediate onset. Proper knowledge of potential adverse events is crucial for clinicians to attempt to decrease complications and improve outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Hadeel Seraj
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Barasain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Basma Bamakhrama
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Khalid Arab
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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10
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Rhinoplasty With Hyaluronic Acid: A Standard 5-step Injection Procedure Using Sharp Needle. Ann Plast Surg 2021; 85:595-600. [PMID: 32756257 DOI: 10.1097/sap.0000000000002516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the clinical effect of rhinoplasty with a standard 5-step injection procedure of hyaluronic acid using sharp needle in correction of deficient features of the Chinese nose. METHODS Between January 2016 and December 2018, hyaluronic acid was injected with the sharp needle by a standard procedure in the anterior nasal spine, nasal columella, nasal tip, nasal root, and dorsum, as well as the junction region of nasal root and brow in 198 Chinese patients. The postoperative curative effect was analyzed, and the adverse reactions were observed. RESULTS The nasal shape in all patients was significantly improved, obtaining the stereoscopic appearance, and satisfactory results. During a 6-month follow-up, 4 patients developed local subcutaneous congestion and bruising in the nasal dorsum after treatment, which disappeared within 2 weeks. No patients suffered from complications such as infection, embolism, necrosis, transparent nasal dorsum, and widened nasal roots. CONCLUSIONS Injection of hyaluronic acid with the sharp needle by a standard 5-step procedure is a safe technique that can effectively correct the deficient features of the Chinese nose.
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11
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Nagendran ST, Ali MJ, Dogru M, Malhotra R. Complications and Adverse Effects of Periocular Aesthetic Treatments. Surv Ophthalmol 2021; 67:741-757. [PMID: 33933438 DOI: 10.1016/j.survophthal.2021.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The popularity and variety of temporary and permanent periocular aesthetic treatments has increased over the past decade. Patients frequently present to eye clinics with ocular complications and side effects following these treatments, their severity ranging from ocular irritation from dry eyes to visual loss from vascular occlusion. A careful, thorough history is essential, as many patients may not associate aesthetic procedures with ocular complications, and some may be embarrassed to disclose this information. All ophthalmologists should understand the potential ocular sequelae of these treatments and be able to initiate treatment in sight-threatening cases. Wesummarises the current literature on ophthalmic complications of the most common periocular aesthetic treatments.
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Affiliation(s)
- Sonali T Nagendran
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom.
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Abstract
Purpose of the present study is to objectively evaluate the number of severe vascular complications, represented by skin necrosis and vision loss or impairment, following facial filler injection. The investigators implemented a review of the literature including articles published on PubMed database without limitation about year of publication, including all reports concerning skin necrosis and vision loss or impairment related to the injection of fillers for cosmetic uses. The search highlighted 45 articles and a total of 164 cases of skin necrosis and vision loss or impairment after injection of different substances. The injection site most frequently associated with complications was the nose (44.5%), followed by glabella (21%), nasolabial fold (15%), and forehead (10%). Results of the present study suggest that injectable filler can cause severe complications even in expertized hands. Treatments in the new defined "Dangerous triangle" must be carefully carried out. Despite our expectations, the highest rates of sever adverse events have been associated with autologous fat transfer practice.
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13
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Jones DH, Fitzgerald R, Cox SE, Butterwick K, Murad MH, Humphrey S, Carruthers J, Dayan SH, Donofrio L, Solish N, Yee GJ, Alam M. Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations From the American Society for Dermatologic Surgery Multidisciplinary Task Force. Dermatol Surg 2021; 47:214-226. [PMID: 33543879 DOI: 10.1097/dss.0000000000002921] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Derek H Jones
- Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California
| | | | - Sue Ellen Cox
- Aesthetic Solutions, Assoc Clinical Faculty, UNC Department of Dermatology, Consulting Associate, Duke University Department Dermatology, Chapel Hill, North Carolina
| | | | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jean Carruthers
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Steven H Dayan
- Denova Research, Clinical Assistant Professor, University of Illinois, Chicago, Illinois
| | - Lisa Donofrio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Nowell Solish
- Department of Dermatology, University of Toronto, Toronto, Canada
| | | | - Murad Alam
- Departments of Dermatology, Otolaryngology, and Surgery, Northwestern University, Chicago, Illinois
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14
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Thulesen J. Iatrogenic vision loss following aesthetic treatment with hyaluronic acid‐containing filler: Every injector should be prepared. Dermatol Ther 2020; 33:e13913. [DOI: 10.1111/dth.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jesper Thulesen
- Clinic Aesthetica Kongens Nytorv Copenhagen Denmark
- Hovedstadens Eye Clinic Copenhagen Denmark
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15
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Abstract
BACKGROUND Soft-tissue filler administration is an increasingly popular minimally invasive cosmetic procedure. Simultaneously, there have been a greater number of adverse events reported, including the devastating complication of blindness. OBJECTIVE To report cases of filler-related blindness published since 2015. MATERIALS AND METHODS The Ovid MEDLINE database was searched from January 1, 2015, to August 1, 2018, using a previously described Boolean string. RESULTS Sixty new cases of filler blindness were identified. The most common type of filler reported was hyaluronic acid (HA) (N = 42, 70.0%), followed by autologous fat (N = 7, 11.7%), and calcium hydroxyapatite (CaHA) (N = 7, 11.7%). The most common injection locations were the nose (N = 33, 55.0%), glabella (N = 21, 35.0%), and forehead (N = 11, 18.3%). Ten cases reported vision restoration (16.7%). Four of the successful cases involved hyaluronidase administration, including 1 retrobulbar hyaluronidase injection. CONCLUSION Since 2015, there have been 60 newly reported cases of soft-tissue filler blindness. Most recent cases have occurred with HA, which is a shift from previous reports. In HA cases, hyaluronidase injection may be successful in restoring vision if administered promptly. It is imperative for providers to be familiar with strategies for managing soft-tissue filler blindness.
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16
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Aviv U, Haik J, Weiss N, Berl A, Ofir H, Nardini G, Cleary M, Kornhaber R, Harats M. Treatment Algorithm for Hyaluronic Acid-Related Complication Based on a Systematic Review of Case Reports, Case Series, and Clinical Experience. Craniomaxillofac Trauma Reconstr 2020; 13:313-328. [PMID: 33456703 DOI: 10.1177/1943387520952687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design Systematic review of hyaluronic acid (HA)-related complications. Objective To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection. Methods This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients. Results The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects. Conclusion Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection.
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Affiliation(s)
- Uri Aviv
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,These authors contributed equally to this work
| | - Josef Haik
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia.,These authors contributed equally to this work
| | - Nathaniel Weiss
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Ariel Berl
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Hagit Ofir
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michelle Cleary
- College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia
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17
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Nonsurgical Rhinoplasty: A Systematic Review of Technique, Outcomes, and Complications. Plast Reconstr Surg 2020; 146:41-51. [DOI: 10.1097/prs.0000000000006892] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Kapoor KM, Kapoor P, Heydenrych I, Bertossi D. Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature. Aesthetic Plast Surg 2020; 44:929-944. [PMID: 31822960 DOI: 10.1007/s00266-019-01562-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/25/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND With the global increase in the use of injectable fillers, more cases with serious adverse events such as skin ischemia and vision loss are being reported. This article aims to review the role of HA fillers, as a subgroup separate from fat graft and non-HA fillers, in causing vision loss and to elucidate various features and outcomes of post-HA filler vision loss. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A total of 29 articles presenting 60 unique cases of post-HA filler vision loss were identified in the literature. Based on various inclusion and exclusion criteria, 26 articles with details of 44 cases were included in this study. RESULTS The majority of cases were seen in women and in the 20-40 years age group. The maximum number of cases was reported from Korea, followed by China. Nearly half of the cases reported after HA filler-related visual complications had partial loss of sight, hence 'partial vision loss' and 'complete vision loss' were used as differentiating descriptive terms to the degree of 'blindness.' Nearly all the cases were unilateral, with immediate onset of visual signs and symptoms. The nose, glabella, and forehead were the most commonly implicated areas, while no cases of post-HA filler vision loss were reported from lower face anatomical areas, including the chin, jawline, and lips. Partial vision loss after HA filler has a better prognosis than complete vision loss. HA filler volumes as low as 0.2 ml can cause permanent, complete vision loss, which is suggestive of the embolic nature of HA filler blockage. Ophthalmic artery occlusion (OAO) and central retinal artery occlusion (CRAO) were the two most commonly involved arterial obstruction patterns followed by branch retinal artery occlusion (BRAO). BRAO is the most favorable involved arterial pattern for a chance of recovery after HA filler-related vision loss while CRAO and OAO patterns carry a very poor prognosis. CONCLUSION Post-HA filler vision loss is nearly always of immediate onset. Partial vision loss after HA filler injection with the involvement of smaller branches of the retina, other than central retinal artery or ophthalmic artery, has more favorable visual outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Krishan Mohan Kapoor
- Anticlock Clinic, #1508, Sector 33 D, Chandigarh, 160022, India.
- Department of Plastic Surgery, Fortis Hospital, Mohali, India.
- St George's, University of London, London, UK.
| | - Puneet Kapoor
- Anticlock Clinic, #1508, Sector 33 D, Chandigarh, 160022, India
| | - Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South Africa
- Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Dario Bertossi
- Maxillofacial Surgery Division, University of Verona, Verona, Italy
- Casa di cura La Madonnina, Studio Macaluso piazza Lima 1 Milano, Centro di medicina via montebaldo 12 Calzoni di Villafranca Verona, Milan, Italy
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19
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Kim BJ, You HJ, Jung I, Kim DW. Ophthalmoplegia with skin necrosis after a hyaluronic acid filler injection. J Cosmet Dermatol 2020; 19:1307-1310. [PMID: 32281282 DOI: 10.1111/jocd.13403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 11/26/2022]
Abstract
Hyaluronic acid filler injection is commonly used for aesthetic purposes. However, many clinicians neglect the possibility of developing vascular occlusion and its devastating sequelae. Besides visual loss after iatrogenic ophthalmic artery occlusion, ophthalmoplegia without blindness is rare but may occur. Here, we report a 23-year-old woman with ptosis, lateral deviation of the right eye, and skin necrosis after hyaluronic acid filler injection. After hyaluronidase injection and steroid pulse therapy, ptosis and eye movement were completely restored. Skin necrosis was treated with a human epithelial growth factor ointment, followed by Nd:YAG laser. Complete healing with minimal scar was achieved.
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Affiliation(s)
- Beom-Jun Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ileok Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
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20
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Graue G, Ochoa Araujo DA, Plata Palazuelos C, Núñez Medrano JÁ, López San Juan FJ, Sánchez Pereda D, Capiz Correa DR, de Velasco L. The M.A.STE.R.S algorithm for acute visual loss management after facial filler injection. J Cosmet Dermatol 2020; 19:2859-2866. [PMID: 32270627 DOI: 10.1111/jocd.13393] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To propose an algorithm of treatment for sudden visual loss following filler injections and perform an English-written literature search for assignment of evidence level and grade recommendation. METHODS Algorithm of treatment includes ocular physical Maneuvers, hyAluronidase administration, intravenous STEroids, intraocular pressure Reduction, and Supplemental Oxygen (M.A.STE .R.S) based on previous acute management reports. Special consideration for algorithm buildup was made for ophthalmic diseases that share physiopathological features such as central retinal artery occlusion, systemic vasculitis affecting vision, and acute glaucoma. Finally, a systematic cross-review of the reported cases with visual loss was done to identify the level of evidence and grant a recommendation grade. RESULTS A search through PubMed and Medscape databases for English-written scientific papers using the terms facial filler, retinal artery occlusion, management, treatment, complications, and adverse events quoted a total of 46 papers (190 cases) which were then analyzed. A high variability on management for treatment of sudden visual loss after facial filler injections was observed. This was attributed partially to the great diversity of medical specialists performing cosmetic facial procedures such as dermatologists, plastic surgeons, esthetic doctors and ophthalmologists, and the lack of high evidence level studies. CONCLUSIONS The proposed algorithm provides an initial guideline based on prior literature reports and physiopathology involving facial filler injection complications. Analysis identified 22 successfully treated cases with vision recovery (11.57%). Ocular physical maneuvers had the best evidence-based level and grade recommendation (A) for the management of acute vision loss secondary to facial filler injections.
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Affiliation(s)
- Gerardo Graue
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico.,Periocular Cosmetic Clinic, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
| | - Dora Aline Ochoa Araujo
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
| | | | | | | | | | - Daniel Raúl Capiz Correa
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico.,Ophthalmic Pathology Division, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
| | - Leopoldo de Velasco
- Orbit and Oculoplastic Department, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico.,Periocular Cosmetic Clinic, Hospital Nuestra Sra. De la Luz I.A.P., Mexico City, Mexico
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21
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Topography of the Central Retinal Artery Relevant to Retrobulbar Reperfusion in Filler Complications. Plast Reconstr Surg 2019; 144:1295-1300. [DOI: 10.1097/prs.0000000000006205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Lee W, Koh IS, Oh W, Yang EJ. Ocular complications of soft tissue filler injections: A review of literature. J Cosmet Dermatol 2019; 19:772-781. [PMID: 31709739 DOI: 10.1111/jocd.13213] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/03/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Soft tissue filler is commonly used for facial contouring. However, incorrect use can lead to severe ocular complications. Even though filler injections are quite different from fat grafts, they are considered similar procedures. However, to date, there are no proven preventive measures or treatments for blindness secondary to soft tissue filler injections. OBJECTIVES This literature review aimed to investigate visual compromise secondary to soft tissue filler injection and discuss the related vascular anatomy, pathophysiology, and prevention of ocular complications of soft tissue filler injections. METHODS A literature search until July 2018 was performed for reports on visual compromise after filler injections. We evaluated the previous literature and eliminated cases using fat grafts and unknown fillers. RESULTS A total of 50 reports of filler-induced visual compromise were identified. Analysis of these cases showed that the procedure with greatest risk was nasal augmentation, followed by glabellar wrinkle treatment. Within the last 3 years searched, 35% of reported cases involved treatment of the nose. There were no reports of blindness from injections into the temple or chin and relatively few case reports involving forehead injections. CONCLUSION The most common injection site associated with blindness in a previous report was the glabella; however, the most common site currently associated with blindness due to filler injections was the nose. Extreme caution is necessary when performing nasal augmentation or glabellar wrinkle correction using soft tissue fillers to avoid the branches of the internal carotid artery.
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Affiliation(s)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea
| | - Ik-Soo Koh
- Kohiksoo Plastic Surgery Clinic, Seoul, South Korea
| | - Wook Oh
- Samsung Feel Clinic, Seoul, South Korea
| | - Eun-Jung Yang
- Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
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23
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Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J 2019; 39:662-674. [PMID: 30805636 DOI: 10.1093/asj/sjz053] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sudden loss of vision secondary to filler treatments is a rare but catastrophic complication. OBJECTIVES The aim of this study was to update the published cases of blindness after filler injection that have occurred since we published our review of 98 cases in 2015, and to discuss prevention and management strategies. METHODS A literature review was performed to identify all cases of visual complications caused by filler injection identified between January 2015 and September 2018. RESULTS Forty-eight new published cases of partial or complete vision loss after filler injection were identified. The sites that were highest risk were the nasal region (56.3%), glabella (27.1%), forehead (18.8%), and nasolabial fold (14.6%). Hyaluronic acid filler was the cause of this complication in 81.3% of cases. Vision loss, pain, ophthalmoplegia, and ptosis were the most common reported symptoms. Skin changes were seen in 43.8% of cases and central nervous system complications were seen in 18.8% of cases. Ten cases (20.8%) experienced complete recovery of vision, whereas 8 cases (16.7%) reported only partial recovery. Management strategies varied greatly and there were no treatments that were shown to be consistently successful. CONCLUSIONS Although the risk of blindness from fillers is rare, practitioners who inject filler should have a thorough knowledge of this complication including prevention and management strategies. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Katie Beleznay
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Humphrey
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
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24
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Chatrath V, Banerjee PS, Goodman GJ, Rahman E. Soft-tissue Filler-associated Blindness: A Systematic Review of Case Reports and Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2173. [PMID: 31321177 PMCID: PMC6554164 DOI: 10.1097/gox.0000000000002173] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the increase in the use of soft-tissue fillers worldwide, there has been a rise in the serious adverse events such as vascular compromise and blindness. This article aims to review the role of fillers in causing blindness and the association between hyaluronic acid (HA) filler and blindness. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to report this review. RESULTS A total of 190 cases of blindness due to soft-tissue fillers were identified, of which 90 (47%) cases were attributed to autologous fat alone, and 53 (28%) cases were caused by HA. The rest of the cases were attributed to collagen, calcium hydroxylapatite, and other fillers. CONCLUSIONS Autologous fat was the most common filler associated with blindness despite HA fillers being the most commonly used across the globe. However, the blindness caused by other soft-tissue fillers like collagen and calcium hydroxylapatite was represented. It was also evident through the review that the treatment of HA-related blindness was likely to have better outcomes compared with other fillers due to hyaluronidase use.
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Affiliation(s)
- Vandana Chatrath
- From the Postgraduate Medical Institute, Faculty of Medical Sciences, Anglia Ruskin University, Chelmsford, Essex, CM1 1SQ United Kingdom
- Delhi Dermatology Group, New Delhi, India
| | | | | | - Eqram Rahman
- Institute of Medical and Biomedical Education, St. George’s University of London, Cranmer Terrace, Tooting Broadway, SW17 0RE London, United Kingdom
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25
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A Case of Hyaluronic Acid Induced Blindness With Ophthalmoplegia and Ptosis. Ophthalmic Plast Reconstr Surg 2018; 34:e184-e186. [DOI: 10.1097/iop.0000000000001234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Sharudin SN, Ismail MF, Mohamad NF, Vasudevan SK. Complete recovery of filler-induced visual loss following subcutaneous hyaluronidase injection. Neuroophthalmology 2018; 43:102-106. [PMID: 31312234 DOI: 10.1080/01658107.2018.1482358] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022] Open
Abstract
The rise in popularity of hyaluronic acid (HA) dermal filler injection has caused an exceptional increase in the number of cases of reported irreversible blindness. Here, we reported a case of ischemic optic neuropathy and ophthalmoplegia following subcutaneous HA filler injection with complete visual recovery. A 31-year-old Chinese woman presented with sudden onset of right monocular visual impairment associated with diplopia. Patient had received a hyaluronic acid-containing filler injection for nasal dorsum augmentation twelve hours prior to presentation. Visual acuity of the right eye was counting finger. A right relative afferent pupillary defect was demonstrated with ophthalmoplegia. Humphrey visual field test disclosed a right inferior altitudinal field defect with impairment of colour vision. Computed tomography of the orbit revealed mild enlargement of the right medial and inferior recti muscles. Our patient showed a tremendous improvement of vision after a subcutaneous hyaluronidase injection with complete visual recovery within 2 weeks.
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Affiliation(s)
- Siti Nurhuda Sharudin
- Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Mohamad Fathi Ismail
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Nor Fadhilah Mohamad
- Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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27
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Abstract
PURPOSE OF REVIEW The use of injectable fillers for nonsurgical rhinoplasty has increased tremendously over the past decade. This review describes the most commonly used fillers and their indications in the context of recent reports of both their successes and failures. RECENT FINDINGS Hyaluronic acid and calcium hydroxylapatite are the two most commonly used fillers for injection. Recent studies have found that most injectable fillers are met with success and patient satisfaction, but vascular complications are still a serious problem of which physicians should be wary. SUMMARY Injectable fillers should continue to be considered for patients on a case-by-case basis, but physicians should be knowledgeable of the various filler types, their indications, and injection technique to prevent serious complications.
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28
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Tan P, Kwong TQ, Malhotra R. Non-aesthetic indications for periocular hyaluronic acid filler treatment: a review. Br J Ophthalmol 2017; 102:725-735. [PMID: 29146758 DOI: 10.1136/bjophthalmol-2017-310525] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/09/2017] [Accepted: 10/13/2017] [Indexed: 11/04/2022]
Abstract
Dermal fillers have been in use for many years for aesthetic rejuvenation of the face. More recently, however, fillers have been increasingly used as an alternative to traditional surgical procedures for non-aesthetic indications. These indications include lagophthalmos, eyelid malpositions and orbital volume deficiency. The advantages of these filler injections are multiple: minimally invasive, repeatable, titratable and even reversible (depending on the product used). We review the current literature of functional uses of filler injections as mentioned above and evaluate the safety profile and efficacy of filler injections for this purpose.
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Affiliation(s)
- Petrina Tan
- Ophthalmology, National University Health Systems, Ng Teng Fong General Hospital, Singapore, Singapore.,Corneo-plastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | - Raman Malhotra
- Corneo-plastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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29
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Szantyr A, Orski M, Marchewka I, Szuta M, Orska M, Zapała J. Ocular Complications Following Autologous Fat Injections into Facial Area: Case Report of a Recovery from Visual Loss After Ophthalmic Artery Occlusion and a Review of the Literature. Aesthetic Plast Surg 2017; 41:580-584. [PMID: 28233134 PMCID: PMC5440494 DOI: 10.1007/s00266-017-0805-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 01/24/2023]
Abstract
With the increase in popularity of the use of cosmetic fillers in plastic and esthetic surgery, the possibility of severe ocular complications should not be neglected. Of the fillers used, autologous fat is the most common to cause permanent visual deterioration, one of the most severe complications associated with the use of cosmetic fillers. Here we present the first report of a complete recovery of visual acuity from an instance of visual loss with no light perception caused by ophthalmic artery occlusion of the right eye following autologous fat injection in the facial area. Immediate ophthalmological intervention and comprehensive therapy with prostaglandins and vinpocetine made it possible to restore retinal perfusion and achieve complete recovery of visual acuity. Awareness of the iatrogenic artery occlusions associated with facial fillers and the need for immediate treatment should be popularized among injectors to prevent devastating consequences, such as permanent vision loss. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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