en.Wedoany.com Reported - Medical student Seline Rasheed and colleagues at Lueur Aesthetic Clinic in Dubai described the diagnosis and management process of vascular occlusion following dermal filler injection in a case report, providing a reference for safe practices in aesthetic medicine.
A patient presented to the emergency department of a hospital in Dubai with swelling, pallor, and skin discoloration after receiving hyaluronic acid filler injections in the nasolabial folds and upper lip. The patient received a total of 0.6 mL of hyaluronic acid filler. After injecting 0.1 mL into the left nasolabial fold, the physician initially noted localized pallor but considered it a normal reaction and continued the injection. The patient's medical, family, social, substance use, travel, and allergy histories were unremarkable.
Upon admission, vital signs showed that the patient's respiratory rate, heart rate, blood pressure, oxygen saturation in room air, and body temperature were all within normal ranges. Inspection, auscultation, palpation, and percussion confirmed the findings from the history, while localized capillary refill time was observed to be prolonged to over 3 seconds, and buccal mucosal discoloration suggested tissue ischemia.
Due to suspected vascular occlusion, a Doppler ultrasound examination was performed. Results showed reduced Doppler flow in the affected area and absence of perforator vessels. Hypoperfusion was present in the left cheek area, left nasolabial fold, and left upper lip, with occlusion of the angular artery and superior labial artery. Hypoechoic hyaluronic acid deposits were found in the left nasolabial fold and upper lip, compressing local blood vessels.
Treatment measures included ultrasound-guided injection of hyaluronidase into the affected areas. After allergy testing, a total of 1560 IU of hyaluronidase was administered in two cycles: 960 IU injected into the left nasolabial fold, 450 IU into the left upper lip, and 150 IU into the left cheek area. This was supplemented with topical nitroglycerin spray and gentle facial massage to promote tissue reperfusion.
Within one month, the patient's symptoms completely resolved without any permanent skin damage.
The authors of the case report noted that this case reinforces the importance of post-injection monitoring and the need for rapid and effective action when vascular compromise is suspected. They recommend incorporating ultrasound follow-up into routine workflows in aesthetic medical practice to enhance the safety and accuracy of filler injections.
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