Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

Complete Vision Recovery After Filler-Induced Blindness Using Hyperbaric Oxygen Therapy: Case Report and Literature Review

Injecting soft-tissue fillers, such as hyaluronic acid, has become an extremely popular method of facial augmentation. Although rare, adverse effects, ranging from cosmetically dissatisfactory to dangerous, may occur. The most severe adverse effect of these is vascular occlusion of the central retinal artery, resulting in vision loss. Protocols for the treatment of filler-induced blindness have not been well established, but there is evidence to suggest that hyperbaric oxygen therapy (HBOT) may aid in the therapeutic algorithm for filler-induced blindness. We present a clinical case of filler-induced blindness successfully treated with prompt administration of HBOT. A 38-year-old healthy female presented to the emergency room after immediate pain and complete vision loss following an at-home injection of mail-order filler into the left glabella and medial eyebrow. After treatment with hyaluronidase and ocular massage, neither of which relieved her symptoms, she received HBOT within 10 h of the injury, after which her vision improved significantly. After 2 additional sessions, the patient had complete vision recovery. This case report contributes to the very sparse literature documenting successful treatment of filler-induced blindness using HBOT, advocating for further study, and possible incorporation into the treatment algorithm for filler-induced blindness. Improper soft-tissue filler administration possesses a potential risk of severe adverse effects. It is crucial that the medical community is aware of treatments that offer the highest chance of visual recovery and sustained benefit for patients.

Level of Evidence 5

Oops I did it (again): Patient experiences of complications after non-invasive cosmetic procedures

Whereas several quantitative studies have measured the impact of complications after cosmetic procedures on patients' lives, little qualitative research is available. To address this gap, we interviewed 20 patients attending a special filler complication consultation hour in the Netherlands. We conducted a reflexive thematic analysis, which resulted in three main themes: (1) complications: a patient's journey; (2) complications: the impact of procedures gone wrong; and (3) complications: a filler-free future? Throughout the interviews, the multifaceted impact of the complications was illustrated, which ultimately also demonstrated participants' negotiation of (negative) experiences with complications after cosmetic procedures within a neoliberal, consumerist environment. Within this context, particular discourses were advanced as others were obscured and/or rejected. Most significantly, issues of stigmatization and shame were tangible throughout the interviews as participants felt they (must) accept responsibility for the consequences of their own consumerist decision to undergo cosmetic procedures. Moreover, the participants' decision to undergo further cosmetic procedures after their complication illustrate the normality, or even normativity, of contemporary beauty practices. A final note regards some important implications for the industry in relation to providing adequate complication care.

Percutaneous Intra-arterial Hyaluronidase Injection for Hyaluronic Acid Filler Embolism Threatening Skin Barrier Integrity: Implementation of a Stepwise Treatment Protocol

BACKGROUND

Hyaluronic acid (HA) filler-induced vascular embolism that threatens skin integrity is an urgent situation. There is increasing evidence that percutaneous intra-arterial hyaluronidase injection is an effective therapeutic technique for it. However, until now, there is a lack of a unifying protocol about the technique.

OBJECTIVES

This study aims to provide a conclusion of percutaneous intra-arterial hyaluronidase injection along with adjunctive measures on the treatment of occlusions precipitated by HA-based filler and develop a stepwise treatment protocol.

METHODS

We searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords.

RESULTS

High-dose, pulsed hyaluronidase is the mainstay for the treatment of HA filler-induced embolism, but percutaneous intra-arterial hyaluronidase injection is a more effective technique. Until now, hyaluronidase is injected into three arteries percutaneously, including facial artery, supratrochlear artery, and superficial temporal artery. Furthermore, the adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and CGF should be considered.

CONCLUSION

Vascular occlusions that threaten skin integrity are an urgent matter which requires accurate diagnosis and effective intervention. Percutaneous intra-arterial hyaluronidase injection along with adjunctive measures performed in a stepwise manner is key to an optimal outcome.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Social Media in Aesthetic Dermatology: Analysis of the Users Behind the Top Filler Posts

BACKGROUND

Within the aesthetic realm, the influence of social media is quite prominent, with a growing percentage of patients using this technology to seek out health care recommendations and education.

OBJECTIVE

To ascertain the most accurate representation of what our patients may encounter on social media, we sought to characterize the top posts on the most popular visually-based social media platform (Instagram).

MATERIALS AND METHODS

We queried Instagram with variations of hashtags related to filler to determine which hashtags had the greatest number of posts associated with them. We then reviewed the top 100 posts associated with the top 9 hashtags, making note of whether the poster was a physician or nonphysician and whether an off-label procedure was performed or discussed.

RESULTS

Most (85.6%) of the 900 reviewed posts were written by nonphysicians, and most (84.6%) of the posts focused on off-label procedures were posted by nonphysicians. Among the physician posters, the most common specialties were Plastic Surgery and Family Medicine, followed by Dermatology.

CONCLUSION

At a time when patients are increasingly turning to social media for health care recommendations and education, most "top" content related to soft tissue augmentation is being provided by nonphysicians, many of whom are performing off-label procedures.