ABSTRACT
Nonsurgical rhinoplasty using filler injections is a popular procedure; however, it carries risks of significant complications, including vascular occlusion, skin necrosis, blindness, and cerebral ischemia. We present a case of septal necrosis after nonsurgical rhinoplasty and describe management using ultrasound guidance. Awareness of this complication and high clinical index of suspicion are necessary for early diagnosis and treatment, crucial to minimizing permanent sequelae. We show that high-definition ultrasound can help to guide the management and improve the treatment outcomes.
ABSTRACT
Foreign body granulomas associated with polycaprolactone (PCL) filler injections are rare, yet challenging to manage. Multiple management modalities have been described. Here, we present a literature review and describe a case of histologically confirmed PCL-related granuloma, treated using ultrasound-guided injections of triamcinolone, hyaluronidase, and 5-fluorouracil combined with oral prednisolone and doxycycline.
ABSTRACT
Filler-related vascular occlusion (VO) treatment remains challenging despite established protocols, including high-dose pulsed hyaluronidase injections and ultrasound-guided targeted injections. Managing patients' pain and anxiety during treatment presents additional difficulties. Nitrous oxide (N2O) has been found to be effective for analgesia and anxiolysis in minor procedures, with a 55% reduction in photodynamic therapy pain, and a visual analog scale reduction from 6.6 to 2.9 for aesthetic laser treatment pain. Use of N2O for analgesia, anxiolysis, or improvement of perfusion in VO has not been previously reported. We present two cases of filler-related VO management with high-dose hourly hyaluronidase injections and adjunctive use of self-administered 50% N2O. Pain and anxiety of the treatment were self-reported by the patients. Capillary refill and livedo reticularis were monitored for establishing VO diagnosis and treatment outcome. In both cases, self-administration of N2O led to contemporaneous improvement in skin perfusion. Patients reported decreased anxiety and pain during treatment. Hyaluronidase treatment led to permanent resolution of occlusion symptoms. N2O presents a promising adjunctive treatment option for relief of pain and anxiety, and potentially additional perfusion improvement. Further investigation is necessary to better define N2O's role in treating VO.
ABSTRACT
Temple filler volumization can significantly improve facial balance and appearance, but has significant risks, including contour irregularities, vascular occlusion, skin necrosis, hair loss, blindness, stroke, and nonthrombotic pulmonary embolism. To improve the safety and precision of temple volumization, we have introduced ultrasound-guided injections of hyaluronic acid filler. We use the interfascial space as a target for our filler placement. We review relevant anatomy, including figures, describe a technique of ultrasound-guided filler injection in the interfascial plane with real-time visualization of the cannula and filler deposition, and include a detailed video of the procedure.
