van Loghem J, Funt D, Pavicic T, Goldie K, Yutskovskaya Y, Fabi S, Siebenga P, Thuis J, Hkeik J, Kadouch J, Prager W, Azib N, Casabona G, Dayan S, Bay Aguilera S, Snozzi P, Saeed P, et al.
Journal of cosmetic dermatology. Date of publication 2020 Nov 1;volume 19(11):2845-2858.
1. J Cosmet Dermatol. 2020 Nov;19(11):2845-2858. doi: 10.1111/jocd.13353. Epub
2020 Mar 17.
Managing intravascular complications following treatment with calcium
hydroxylapatite: An expert consensus.
van Loghem J(1), Funt D(2)(3)(4), Pavicic T(5), Goldie K(6), Yutskovskaya Y(7),
Fabi S(8), Siebenga P(1), Thuis J(1), Hkeik J(9), Kadouch J(10), Prager W(11),
Azib N(12), Casabona G(13), Dayan S(14), Bay Aguilera S(15), Snozzi P(16), Saeed
P(1)(17).
Author information:
(1)Falck Clinic, Aesthetic Medicine Centre, Amsterdam, The Netherlands.
(2)Mount Sinai School of Medicine, New York, NY, USA.
(3)Mount Sinai School of Medicine, Garden City, NY, USA.
(4)Mount Sinai School of Medicine, Woodmere, NY, USA.
(5)Private Practice for Dermatology and Aesthetics, Munich, Germany.
(6)European Medical Aesthetics Ltd, London, UK.
(7)Dermatovenerology and Cosmetology Department, Pacific State Medical,
University of Health, Moscow, Russia.
(8)Department of Dermatology, University of California, San Diego, CA, USA.
(9)All Saints Clinic, Double Bay, Sydney, NSW, Australia.
(10)ReSculpt Clinic, Practice for Aesthetic Dermatology, Amsterdam, The
Netherlands.
(11)Prager & Partner Dermatologische Praxis, Hamburg, Germany.
(12)Dr. Azib Private Praxis, Rabbat, Morocco.
(13)Scientific Department, Ocean Clinic, Marbella, Spain.
(14)Division of Facial Plastic and Reconstructive Surgery, Department of
Otolaryngology, University of Illinois at Chicago, Chicago, IL, USA.
(15)Department of Dermatology, Nova Southeastern University College of
Osteopathic Medicine, Fort Lauderdale, FL, USA.
(16)Smoothline Clinic, Zürich, Switzerland.
(17)Departments of Ophthalmology and Endocrinology, Orbital Center, Academic
Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Comment in
Dermatol Surg. 2023 Feb 1;49(2):218-220. doi: 10.1097/DSS.0000000000003667.
BACKGROUND: Inadvertent intra-arterial injection of dermal fillers including
calcium hydroxylapatite (CaHA) can result in serious adverse events including
soft tissue necrosis, permanent scarring, visual impairment, and blindness. When
intra-arterial injection occurs, immediate action is required for optimal
outcomes, but the infrequency of this event means that many physicians may never
have experienced this scenario. The aim of this document is to provide
evidence-based and expert opinion recommendations for the recognition and
management of vascular compromise following inadvertent injection of CaHA.
METHODS: An international group of experts with experience in injection of CaHA
and management of vascular complications was convened to develop a consensus on
the optimal management of vascular compromise following intra-arterial CaHA
injection. The consensus members were asked to provide preventative advice for
the avoidance of intravascular injection and to produce a treatment protocol for
acute and delayed presentation. To ensure all relevant treatment options were
included, the recommendations were supplemented with a PubMed search of the
literature.
RESULTS: For prevention of intra-arterial CaHA injection, consensus members
outlined the importance of a thorough knowledge of facial vascular anatomy and
patient history, as well as highlighting potential risk zones and optimal
injection techniques. Individual sections document how to recognize the symptoms
of vascular occlusion leading to vision loss and tissue necrosis as well as
detailed treatment protocols for the management of these events. For impending
tissue necrosis, recommendations are provided for early and delayed
presentations with treatment protocols for acute and follow-up treatment. A
separate section details the treatment options for open and closed wounds.
CONCLUSIONS: All physicians should be prepared for the eventuality of
intra-arterial injection of a dermal filler, despite its rarity. These consensus
recommendations combine advice from aesthetic experts with the latest reports
from the published literature to provide an up-to-date office-based protocol for
the prevention and treatment of complications arising from intra-arterial CaHA
injection.
© 2020 The Authors. Journal of Cosmetic Dermatology published by Wiley
Periodicals, Inc.
DOI: 10.1111/jocd.13353
PMCID: PMC7687073
PMID: 32185876 [Indexed for MEDLINE]
