Treatment Protocol for Acute Arterial Occlusion Secondary to Facial Revolumization Procedures

Artificial injectable dermal fillers offer minimally invasive and cost-effective alternatives to traditional cosmetic surgical procedures, but are associated with complications and adverse events.

Emergency Medicine 49(5). 2017 May;221-229 | DOI: 10.12788/emed.2017.0030

May 4, 2017|Emergency Medicine

Steven Dominguez, MD, MPH;Shawn Moshrefi, MD;Marek Dobke, MD, PhD

Long-term Sequelae

Despite aggressive intervention, permanent complications of cerebral ischemia, blindness, and severe soft tissue necrosis may occur. In six cases in the literature, patients treated with ocular massage therapy,^7,14carbon dioxide rebreathing,¹⁴ HBO therapy,^7,14oral and IV corticosteroids,^6-9 antiplatelet drugs,⁶ and fibrinolytic agents,^7,16 or mechanical thrombolysis¹⁶ showed no clinical effects. Neither the treated nor the untreated patients in any of these case studies had any return of vision.^4-7,9,20-27

Conclusion

Although artificial dermal fillers such as HA, CaHA, PLLA, and PMMA, and autologous adipose tissue grafts offer a minimally invasive alternative to plastic surgical procedures, they are not without complication or adverse effects, such as the acute arterial occlusion experienced by both of our patients. Patients presenting to the ED with adverse effects from such procedures must be managed promptly, employing the suggested management and treatment protocol, including consultation with ophthalmology, plastic surgery, and neurological services as indicated, to avoid permanent sequela and damage.

References

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