By Redaelli A., Smit R.
THE GROWING USE of fillers in aesthetic medicine can lead to intravenous or intra-arterial injections in rare and unfortunate cases, resulting in significant soft tissue injuries. Most probably, the real incidence of these incidence of complications are underestimated. Good anatomical knowledge and the use of particular techniques can reduce these unwanted sequela to a lower rate of these emergencies. Anyway, in very rare cases, the development of real necrosis can be possible. There are some recommended immediate guidelines that includes mainly: immediate strong massage of the injected area, the use of topical nitroglycerin, warm local compresses and the use of Hyaluronidase following international guidelines, as soon as possible. To improve the healing process, if unfortunately necrosis do appear, there are some unconfirmed suggestions like the use of PRP, hyperbaric chamber, intraarterial hyaluronidase and the use of vasodilators. Without a doubt, all aesthetic doctors would want to be prepared to manage such complications and to know exactly how to avoid and treat them in the best possible way.
The facial artery provides blood supply to the anterior face and is the most important artery of the face. Its involvement in ischemic complications is confirmed by numerous articles especially in the perioral area, and especially with fillers in the nasolabial region.1-6 The facial artery arises from the point of connection of the anterior edge of masseter and the mandibular bone. Then it travels upwards to the medial orbital rim, where it anastomosis with orbital arteries (infraorbital a., supratochlear a.). Along its way until the nasal flare it is located under mimetic muscles in the deep fat layer. Two branches of facial artery (labialis superioris and labialis inferioris) are responsible for the blood supply of the perioral area. As a rule, labialis inferioris artery separates from the facial artery 1.5 cm above the mandibular edge and travels along the lower external edge of orbicularis oris.