Coping with complications is one of the most difficult experiences for an aesthetic medicine specialist, especially when the patient comes from another clinic, because the doctor may not have full clinical information about the previous treatment.
Complications in the form of ischemia and necrosis are especially terrible, because to correct them you need to act quickly and confidently.
This article on estet-portal.com will review a case study Lynn Lowery: vascular occlusion after lip correction with hyaluronic acid filler.
- Complication after lip correction: how it all started
- Making the correct diagnosis
- Treatment tactics for vascular occlusion after HU correctionb
Complication after lip correction: how it all started
A 52-year-old female patient was injected with a needle 1 ml of the well-known hyaluronic acid dermal filler into her lips.
During the injection, something appeared on the upper lip that then resembled a hematoma (Fig.1).
The doctor massaged the "lump" up and out and informed the patient of the possible bruising.
The next day, the woman began to worry about the condition of her lip, and contacted the attending physician, who, after examination, said that it was just a bruise, and the blood supply was not disturbed.
Two days after the treatment, the patient felt severe pain in her lip. She contacted the doctor again, who said it was normal.
Fig. 1: 1 day after correction with filler – hematoma on the upper lip.
Severe pain is not typical for filler correction, so its appearance should be taken as a cry of impending necrosis.
The patient continued to worry over the next few days as the pain got worse and she couldn't eat or drink.
Five days after the initial dermal filler treatment, the patient decided to seek additional help from Lynn Lowery. The patient allowed the specialist to examine her lip despite severe pain (Figure 2 ).
Fig.2: 5 days after lip correction with fillersand.
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Making the correct diagnosis
On examination, the doctor noted extreme discoloration of the skin. This made it possible to determine that necrosis was imminent due to the injection of dermal filler, which caused vascular occlusion.
The doctor suspected that the vascular occlusion was due to the direct injection of dermal filler into the superior labial artery which lies between the mucosa and the musculus orbicularis oris.
The only solution in this case was to dissolve the filler in order to restore tissue perfusion as soon as possible and limit the depth of necrosis.
The doctor explained in detail the cause of the vascular occlusion to the patient, and the need to use hyaluronidase to limit tissue damage and subsequent skin discoloration after occlusionand.
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Treatment tactics for vascular occlusion after lip correction
The patient has consented to the treatment.
lidocaine was injected into the area of necrosis to relieve pain that results from an interruption in blood supply causing cell acidosis.
Fig.3: Patient immediately after injection of hyaluronidase on day 5 after lip correction with fillers.
The doctor examined the damaged tissues and found that, fortunately, only the epidermis and dermis were involved, while maintaining a normal blood supply to the orbicular muscle of the mouth.
Early recognition and treatment is essential to limit subsequent tissue damage in the event of vascular occlusion.
The patient was prescribed:
- 1500 units of hyaluronidase dissolved in 2.5 ml of bacteriostatic saline;
- 300mg aspirin immediately after treatment as a precautionary measure for any local coagulation around the occlusion and limiting platelet aggregation.
The hyaluronidase treatment was repeated twice and the patient was sent home.
The first injection of hyaluronidase gave a good result (Fig.3), although the patient did not feel any change in pain intensity.
The next morning, that is, six days after the initial procedure, the doctor examined the patient and, since she was still in severe pain and her skin was still discolored, injected another 1500 units of hyaluronidase.
The patient was also prescribed hyperbaric oxygen therapy.
Oxygen therapy has been successfully used to treat retinal artery occlusion and is considered an effective adjunct to the treatment of post-filler complications by:
- oxygenation of ischemic tissues;
- swelling reduction;
- improvement of ischemia/reperfusion injury;
- promoting angiogenesis.
In the evening of the same day, the doctor repeated the treatment with hyaluronidase, another 1500 units, and prescribed acyclovir for five days because of the patient's history of herpes.
At this stage, the patient was still in pain and unable to eat normally (Fig. 4).
Fig.4: Patient after 3 courses of hyaluronidase treatment on day 6 after lip correction with fillers.
On the third day of the intervention, seven days after the initial treatment, the patient underwent another session of Hyperbaric Oxygen Therapy (Figure 5).
Fig.5: Patient on day 3 after the start of treatment.
Eight days after the initial procedure and four days after the start of treatment, there was an improvement in tissue perfusion (Fig. 6).
Fig.6: Patient 4 days after start of treatment: 4 courses of hyaluronidase therapy and 2 courses of hyperbaric oxygenation.
As shown in Figure 7, the patient had no residual skin discoloration, although she continued to experience decreased sensation in the left half of her upper lip.
Fig.7: Patient after 9 days from the start of complication therapy.
Such complications are not uncommon in the practice of a specialist in aesthetic medicine, so it is important to be able to properly prevent, recognize, and stop them.
Based on Aesthetics Journal.
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