J Cosmet Med 2019; 3(2): 108-113  https://doi.org/10.25056/JCM.2019.3.2.108
Successful management of nose arterial occlusion and impending skin necrosis after filler injection
Lenzo Ing Heong Ling, MB BCh BAO, FKCCS
GEM Clinic Group, Kuala Lumpur, Malaysia
Lenzo Ing Heong Ling
E-mail: drlenzolih@gemclinic.com.my
Received: November 20, 2019; Revised: December 20, 2019; Accepted: December 20, 2019; Published online: December 31, 2019.
© Korean Society of Korean Cosmetic Surgery. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The growing use of dermal fillers, specifically the use of hyaluronic acid, may be explained by their effectiveness and versatility and their favorable safety profiles. Nevertheless, early and late complications with varying levels of severity may occur. The incidence of complications is low; however, more severe events such as skin ischemia and necrosis, and even visual loss may occur. The main objective of this case report on intravascular filler injection was to provide information on early signs of ischemic skin necrosis to physicians administering cosmetic fillers. This knowledge will facilitate timely management of symptoms, and enable treatment with hyperbaric oxygen therapy (HBOT) to prevent permanent scarring. A case note study of a single 41-year-old female who underwent a combination of treatments including the “high-dose pulsed hyaluronidase” technique, intravenous dexamethasone, HBOT, open dressing with normal saline, and bactigras dressing. Early recognition and immediate application of the correct combination of treatments for intravascular filler injury prevented further skin necrosis, permanent scarring, and the requirement for surgical reconstruction. Recently, as the application of dermal fillers for soft-tissue augmentation has increased, the number of cases reporting adverse reactions has also increased. The most severe and alarming early complication is vascular occlusion. Thus, it is crucial that physicians are familiar with the anatomy of the treated region, type of product used, correct application technique, and possible adverse events to allow immediate recognition and treatment.
Keywords: arterial embolization; dermal filler injection; hyperbaric oxygen therapy; skin necrosis; vascular compromise
  1. Souza Felix Bravo B, Klotz De Almeida Balassiano L, Roos Mariano Da Rocha C, Barbosa De Sousa Padilha C, Martinezt Torrado C, Teixeira Da Silva R, et al. Delayed-type necrosis after soft-tissue augmentation with hyaluronic acid. J Clin Aesthet Dermatol 2015;8:42-7.
    Pubmed KoreaMed
  2. Cohen JL, Biesman BS, Dayan SH, DeLorenzi C, Lambros VS, Nestor MS, et al. Treatment of hyaluronic acid filler-induced impending necrosis with hyaluronidase: consensus recommendations. Aesthet Surg J 2015;35:844-9.
    Pubmed CrossRef
  3. King M. This month’s guideline: management of necrosis. J Clin Aesthet Dermatol 2018;11:E53-7.
    Pubmed KoreaMed
  4. Woodward J, Khan T, Martin J. Facial filler complications. Facial Plast Surg Clin North Am 2015;23:447-58.
    Pubmed CrossRef
  5. Inoue K, Sato K, Matsumoto D, Gonda K, Yoshimura K. Arterial embolization and skin necrosis of the nasal ala following injection of dermal fillers. Plast Reconstr Surg 2008;121:127-8e.
    Pubmed CrossRef
  6. Loh KTD, Phoon YS, Phua V, Kapoor KM. Successfully managing impending skin necrosis following hyaluronic acid filler injection, using high-dose pulsed hyaluronidase. Plast Reconstr Surg Glob Open 2018;6:e1639.
    Pubmed KoreaMed CrossRef
  7. Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg 2009;35 Suppl 2:1672-80.
    Pubmed CrossRef
  8. Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE. Complications following injection of soft-tissue fillers. Aesthet Surg J 2013;33:862-77.
    Pubmed CrossRef
  9. Hong JY, Seok J, Ahn GR, Jang YJ, Li K, Kim BJ. Impending skin necrosis after dermal filler injection: a “golden time” for first-aid intervention. Dermatol Ther 2017;30:e12440.
    Pubmed CrossRef
  10. Henderson R, Reilly DA, Cooper JS. Hyperbaric oxygen for ischemia due to injection of cosmetic fillers: case report and issues. Plast Reconstr Surg Glob Open 2018;6:e1618.
    Pubmed KoreaMed CrossRef

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