By Villegas Sanchez, Eric M. M.D. ,Rios Hernandez, Yajaira M.D. & Mendez España, Mauricio O. M.D
THE POPULARITY OF cosmetic/aesthetic procedures has increased throughout the last few years because of their ability to produce, in most cases, a favorable end result. The second most common procedure in cosmetic medicine is the use of injectable fillers for both anatomical and volume restoration in the face. The increasing demand for these procedures throughout the last few years has resulted in a correlation with the increase number of adverse effects, and most importantly an increase in rare complications such as vascular compromise. In this case, we present a healthy 36-year-old female who had experienced vascular compromise of the glabella region following a hyaluronic acid injection. She presented with localized discomfort and color change of the skin in the treated area, which encompassed the medial part of forehead to the glabella region. This case clearly highlights the importance of being able to recognize vascular compromise early in order to reduce the chance of permanent complications.
Vascular compromise is a rare and under reported complication seen in the use of fillers for facial rejuvenation, and is clearly dependent on volume used, injector technique and site of injection. Due to its high risk of irreversible complications, it is crucial for the injector to be able to recognize a vascular event and allow for aggressive direct treatment in order to restore blood flow. Complications secondary to vascular compromise include partial or total occlusion secondary to extravascular compression, and complete occlusion due to intravascular injection of the filler. Facial irrigation anatomy is complex and must be understood by the injector in order to decrease any chance of vascular occlusion events. Even with the most expert injector it must be understood that the facial areas with the highest risk of adverse effects are the nasolabial folds and the glabella region; due mostly because both the angular artery and supratrochlear artery have little to no collateral irrigation. Presence of adverse effects must be treated immediately in order to decrease chances of irreversible damage such as necrosis and scarring.