Henderson R, Reilly DA, Cooper JS, et al.
Plastic and reconstructive surgery. Global open. Date of publication 2018 Jan 11;volume 6(1):e1618.
1. Plast Reconstr Surg Glob Open. 2018 Jan 11;6(1):e1618. doi:
10.1097/GOX.0000000000001618. eCollection 2018 Jan.
Hyperbaric Oxygen for Ischemia due to Injection of Cosmetic Fillers: Case Report
and Issues.
Henderson R(1), Reilly DA(1), Cooper JS(1).
Author information:
(1)Division of Plastic & Reconstructive Surgery, University of Nebraska Medical
Center, Omaha, Neb.; and Department of Emergency Medicine, University of
Nebraska Medical Center, Omaha, Neb.
Natural and synthetic fillers have revolutionized aesthetic facial rejuvenation
and soft-tissue augmentation. We present a case highlighting the dangers of
filler self-injection. A 37-year-old woman self-injected a dermal filler around
both temples. She immediately experienced left--side hearing loss, blanching
over the left face, and pain. Prompt treatment with hyaluronidase, topical nitro
paste, and warm compresses ensued. An emergency computed tomography angiogram
showed occlusion of a superficial temporal artery branch. We treated her with
enoxaparin, aspirin, dexamethasone, piperacillin-tazobactam, and intradermal
lidocaine. After 6 hyperbaric oxygen therapy (HBO2) treatments in 3 days, the
patient showed improvement in appearance with markedly decreased ischemic
discoloration and her hearing returned to baseline. Algorithms for treating such
injuries generally neglect HBO2. HBO2 is thought to be efficacious in these
situations by a variety of mechanisms: oxygenation of ischemic tissues,
reduction of edema, amelioration of ischemic/reperfusion injury, promotion of
angiogenesis and collagen maturation. Her resolved hearing highlights the
utility of HBO2 in sudden hearing loss as well. Injectors should have guidelines
for using product, not only on patients but staff as well. Filler courses should
include handling complications and include HBO2 in their guidelines. Clinicians
should remind patients to seek treatment from qualified clinicians. The goal of
a bargain price using self-injection may quickly become expensive and
disfiguring.
DOI: 10.1097/GOX.0000000000001618
PMCID: PMC5811288
PMID: 29464158
