Filling injection in facial danger area and related vascular complications_West China Medical Journal

Authors：

CHEN Chiaoju ,  CEN Ying , LI Zhengyong , CHEN Zhixing

Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CEN Ying, Email: cenyinghx@163.com

Keywords：

Facial filling injection; facial filler; facial danger area; vascular complications; safety

DOI：

10.7507/1002-0179.202112134

Video：

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Facial filling injection is one of the technologies to achieve facial rejuvenation in a non-surgical way. With the application of emerging cosmetic filler preparations and the development of new technologies, there are more and more options to achieve facial rejuvenation. Complications may result from the use of new materials whose safety has not been proven in studies. This article describes common facial filler choices, facial risk areas and vascular complications, and discusses how to improve the safety of facial injections. The purpose is to enable operators to fully understand the facial risk area, select the appropriate filling injection, and be able to identify the symptoms of vascular complications as early as possible, thereby improving the safety of facial filling injection.

Citation： CHEN Chiaoju, CEN Ying, LI Zhengyong, CHEN Zhixing. Filling injection in facial danger area and related vascular complications. West China Medical Journal, 2022, 37(6): 951-954. doi: 10.7507/1002-0179.202112134 Copy

1.	Cotofana S, Gaete A, Hernandez CA, et al. The six different injection techniques for the temple relevant for soft tissue filler augmentation procedures - clinical anatomy and danger zones. J Cosmet Dermatol, 2020, 19(7): 1570-1579.
2.	Crowley JS, Kream E, Fabi S, et al. Facial rejuvenation with fat grafting and fillers. Aesthet Surg J, 2021, 41(Suppl 1): S31-S38.
3.	Vargas-Laguna E, García-Gavín J, Bárcena-Ruiz E. Safety in dermatologic procedures: vascular occlusion by filling materials. Actas Dermosifiliogr (Engl Ed), 2021, 10: S0001-7310(21)00177-0.
4.	Bacos JT, Dayan SH. Superficial dermal fillers with hyaluronic acid. Facial Plast Surg, 2019, 35(3): 219-223.
5.	Khosravani N, Weber L, Patel R, et al. The 5-step filler hand rejuvenation: filling with hyaluronic acid. Plast Reconstr Surg Glob Open, 2019, 7(1): e2073.
6.	Trinh LN, Gupta A. Non-hyaluronic acid fillers for midface augmentation: a systematic review. Facial Plast Surg, 2021, 37(4): 536-542.
7.	Christen MO, Vercesi F. Polycaprolactone: how a well-known and futuristic polymer has become an innovative collagen-stimulator in esthetics. Clin Cosmet Investig Dermatol, 2020, 13: 31-48.
8.	Fitzgerald R, Bass LM, Goldberg DJ, et al. Physiochemical characteristics of poly-L-lactic acid (PLLA). Aesthet Surg J, 2018, 38(suppl 1): S13-S17.
9.	Li CN, Wang CC, Huang CC, et al. A novel, optimized method to accelerate the preparation of injectable poly-L-lactic acid by sonication. J Drugs Dermatol, 2018, 17(8): 894-898.
10.	de Almeida AT, Figueredo V, da Cunha ALG, et al. Consensus recommendations for the use of hyperdiluted calcium hydroxyapatite (radiesse) as a face and body biostimulatory agent. Plast Reconstr Surg Glob Open, 2019, 7(3): e2160.
11.	Goldie K, Peeters W, Alghoul M, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg, 2018, 44(Suppl 1): S32-S41.
12.	Liu MH, Beynet DP, Gharavi NM. Overview of deep dermal fillers. Facial Plast Surg, 2019, 35(3): 224-229.
13.	Nebel A, Veit F, Weber A, et al. Liquid silicone embolism syndrome (SES) in lungs and liver - a case report. Forensic Sci Int, 2021, 325: 110872.
14.	Gold MH, Sadick NS. Optimizing outcomes with polymethylmethacrylate fillers. J Cosmet Dermatol, 2018, 17(3): 298-304.
15.	Caruana A, Savina D, Macedo JP, et al. From platelet-rich plasma to advanced platelet-rich fibrin: biological achievements and clinical advances in modern surgery. Eur J Dent, 2019, 13(2): 280-286.
16.	Xiong BJ, Tan QW, Chen YJ, et al. The effects of platelet-rich plasma and adipose-derived stem cells on neovascularization and fat graft survival. Aesthetic Plast Surg, 2018, 42(1): 1-8.
17.	Youn CS, Hong JY, Park KY, et al. A review of hydrolifting: a new modality for skin rejuvenation. J Cosmet Laser Ther, 2018, 20(1): 28-33.
18.	Pascali M, Quarato D, Carinci F. Filling procedures for lip and perioral rejuvenation: a systematic review. Rejuvenation Res, 2018, 21(6): 553-559.
19.	Lee W, Koh IS, Oh W, et al. Ocular complications of soft tissue filler injections: a review of literature. J Cosmet Dermatol, 2020, 19(4): 772-781.
20.	Wang HC, Yu N, Wang X, et al. Cerebral embolism as a result of facial filler injections: a literature review. Aesthet Surg J, 2022, 42(3): NP162-NP175.
21.	Wollina U, Goldman A. Facial vascular danger zones for filler injections. Dermatol Ther, 2020, 33(6): e14285.
22.	Cai B, Yuan R, Zhu GZ, et al. Deployment of the ophthalmic and facial angiosomes in the upper nose overlaying the nasal bones. Aesthet Surg J, 2021, 41(12): NP1975-NP1985.
23.	Scheuer JF 3rd, Sieber DA, Pezeshk RA, et al. Facial danger zones: techniques to maximize safety during soft-tissue filler injections. Plast Reconstr Surg, 2017, 139(5): 1103-1108.
24.	Cotofana S, Alfertshofer M, Frank K, et al. Relationship between vertical glabellar lines and the supratrochlear and supraorbital arteries. Aesthet Surg J, 2020, 40(12): 1341-1348.
25.	Talmor G, Trang A, Ahadiat O, et al. Anatomic danger zones of the head and neck. Dermatol Surg, 2020, 46(12): 1549-1559.
26.	Agorgianitis L, Panagouli E, Tsakotos G, et al. The supratrochlear artery revisited: an anatomic review in favor of modern cosmetic applications in the area. Cureus, 2020, 12(2): e7141.
27.	Jitaree B, Phumyoo T, Uruwan S, et al. Clinical implications of the arterial supplies and their anastomotic territories in the nasolabial region for avoiding arterial complications during soft tissue filler injection. Clin Anat, 2021, 34(4): 581-589.
28.	Cohn JE, Pion T, Greco TM. “Not above, not below: right in the middle!” - novel filler technique for temporal augmentation and rejuvenation. Facial Plast Surg, 2020, 36(5): 623-627.
29.	Sorensen EP, Council ML. Update in soft-tissue filler-associated blindness. Dermatol Surg, 2020, 46(5): 671-677.
30.	Kapoor KM, Kapoor P, Heydenrych I, et al. Vision loss associated with hyaluronic acid fillers: a systematic review of literature. Aesthetic Plast Surg, 2020, 44(3): 929-944.
31.	Cen LP, Wang Y, Li Z. Vision loss after facial injection of hyaluronic acid. Ophthalmology, 2020, 127(10): 1330.
32.	Qian H, Ling Y, Zhang M, et al. Massive cerebral infarction following facial injection of autologous fat: a case report and review of the literature. Front Hum Neurosci, 2021, 15: 610945.
33.	Huo X, Liu R, Wang Y, et al. Cerebral fat embolism as complication of facial fat graft: retrospective analysis of clinical characteristics, treatment, and prognosis. World Neurosurg, 2018, 120: 249-255.
34.	Rauso R, Sesenna E, Fragola R, et al. Skin necrosis and vision loss or impairment after facial filler injection. J Craniofac Surg, 2020, 31(8): 2289-2293.
35.	Goodman GJ, Magnusson MR, Callan P, et al. A consensus on minimizing the risk of hyaluronic acid embolic visual loss and suggestions for immediate bedside management. Aesthet Surg J, 2020, 40(9): 1009-1021.
36.	Tansatit T, Jitaree B, Uruwan S, et al. Anatomical study of the dorsal nasal artery to prevent visual complications during dorsal nasal augmentation. Plast Reconstr Surg Glob Open, 2021, 9(11): e3924.
37.	Lee W, Moon HJ, Kim JS, et al. Safe glabellar wrinkle correction with soft tissue filler using doppler ultrasound. Aesthet Surg J, 2021, 41(9): 1081-1089.

1. Cotofana S, Gaete A, Hernandez CA, et al. The six different injection techniques for the temple relevant for soft tissue filler augmentation procedures - clinical anatomy and danger zones. J Cosmet Dermatol, 2020, 19(7): 1570-1579.
2. Crowley JS, Kream E, Fabi S, et al. Facial rejuvenation with fat grafting and fillers. Aesthet Surg J, 2021, 41(Suppl 1): S31-S38.
3. Vargas-Laguna E, García-Gavín J, Bárcena-Ruiz E. Safety in dermatologic procedures: vascular occlusion by filling materials. Actas Dermosifiliogr (Engl Ed), 2021, 10: S0001-7310(21)00177-0.
4. Bacos JT, Dayan SH. Superficial dermal fillers with hyaluronic acid. Facial Plast Surg, 2019, 35(3): 219-223.
5. Khosravani N, Weber L, Patel R, et al. The 5-step filler hand rejuvenation: filling with hyaluronic acid. Plast Reconstr Surg Glob Open, 2019, 7(1): e2073.
6. Trinh LN, Gupta A. Non-hyaluronic acid fillers for midface augmentation: a systematic review. Facial Plast Surg, 2021, 37(4): 536-542.
7. Christen MO, Vercesi F. Polycaprolactone: how a well-known and futuristic polymer has become an innovative collagen-stimulator in esthetics. Clin Cosmet Investig Dermatol, 2020, 13: 31-48.
8. Fitzgerald R, Bass LM, Goldberg DJ, et al. Physiochemical characteristics of poly-L-lactic acid (PLLA). Aesthet Surg J, 2018, 38(suppl 1): S13-S17.
9. Li CN, Wang CC, Huang CC, et al. A novel, optimized method to accelerate the preparation of injectable poly-L-lactic acid by sonication. J Drugs Dermatol, 2018, 17(8): 894-898.
10. de Almeida AT, Figueredo V, da Cunha ALG, et al. Consensus recommendations for the use of hyperdiluted calcium hydroxyapatite (radiesse) as a face and body biostimulatory agent. Plast Reconstr Surg Glob Open, 2019, 7(3): e2160.
11. Goldie K, Peeters W, Alghoul M, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg, 2018, 44(Suppl 1): S32-S41.
12. Liu MH, Beynet DP, Gharavi NM. Overview of deep dermal fillers. Facial Plast Surg, 2019, 35(3): 224-229.
13. Nebel A, Veit F, Weber A, et al. Liquid silicone embolism syndrome (SES) in lungs and liver - a case report. Forensic Sci Int, 2021, 325: 110872.
14. Gold MH, Sadick NS. Optimizing outcomes with polymethylmethacrylate fillers. J Cosmet Dermatol, 2018, 17(3): 298-304.
15. Caruana A, Savina D, Macedo JP, et al. From platelet-rich plasma to advanced platelet-rich fibrin: biological achievements and clinical advances in modern surgery. Eur J Dent, 2019, 13(2): 280-286.
16. Xiong BJ, Tan QW, Chen YJ, et al. The effects of platelet-rich plasma and adipose-derived stem cells on neovascularization and fat graft survival. Aesthetic Plast Surg, 2018, 42(1): 1-8.
17. Youn CS, Hong JY, Park KY, et al. A review of hydrolifting: a new modality for skin rejuvenation. J Cosmet Laser Ther, 2018, 20(1): 28-33.
18. Pascali M, Quarato D, Carinci F. Filling procedures for lip and perioral rejuvenation: a systematic review. Rejuvenation Res, 2018, 21(6): 553-559.
19. Lee W, Koh IS, Oh W, et al. Ocular complications of soft tissue filler injections: a review of literature. J Cosmet Dermatol, 2020, 19(4): 772-781.
20. Wang HC, Yu N, Wang X, et al. Cerebral embolism as a result of facial filler injections: a literature review. Aesthet Surg J, 2022, 42(3): NP162-NP175.
21. Wollina U, Goldman A. Facial vascular danger zones for filler injections. Dermatol Ther, 2020, 33(6): e14285.
22. Cai B, Yuan R, Zhu GZ, et al. Deployment of the ophthalmic and facial angiosomes in the upper nose overlaying the nasal bones. Aesthet Surg J, 2021, 41(12): NP1975-NP1985.
23. Scheuer JF 3rd, Sieber DA, Pezeshk RA, et al. Facial danger zones: techniques to maximize safety during soft-tissue filler injections. Plast Reconstr Surg, 2017, 139(5): 1103-1108.
24. Cotofana S, Alfertshofer M, Frank K, et al. Relationship between vertical glabellar lines and the supratrochlear and supraorbital arteries. Aesthet Surg J, 2020, 40(12): 1341-1348.
25. Talmor G, Trang A, Ahadiat O, et al. Anatomic danger zones of the head and neck. Dermatol Surg, 2020, 46(12): 1549-1559.
26. Agorgianitis L, Panagouli E, Tsakotos G, et al. The supratrochlear artery revisited: an anatomic review in favor of modern cosmetic applications in the area. Cureus, 2020, 12(2): e7141.
27. Jitaree B, Phumyoo T, Uruwan S, et al. Clinical implications of the arterial supplies and their anastomotic territories in the nasolabial region for avoiding arterial complications during soft tissue filler injection. Clin Anat, 2021, 34(4): 581-589.
28. Cohn JE, Pion T, Greco TM. “Not above, not below: right in the middle!” - novel filler technique for temporal augmentation and rejuvenation. Facial Plast Surg, 2020, 36(5): 623-627.
29. Sorensen EP, Council ML. Update in soft-tissue filler-associated blindness. Dermatol Surg, 2020, 46(5): 671-677.
30. Kapoor KM, Kapoor P, Heydenrych I, et al. Vision loss associated with hyaluronic acid fillers: a systematic review of literature. Aesthetic Plast Surg, 2020, 44(3): 929-944.
31. Cen LP, Wang Y, Li Z. Vision loss after facial injection of hyaluronic acid. Ophthalmology, 2020, 127(10): 1330.
32. Qian H, Ling Y, Zhang M, et al. Massive cerebral infarction following facial injection of autologous fat: a case report and review of the literature. Front Hum Neurosci, 2021, 15: 610945.
33. Huo X, Liu R, Wang Y, et al. Cerebral fat embolism as complication of facial fat graft: retrospective analysis of clinical characteristics, treatment, and prognosis. World Neurosurg, 2018, 120: 249-255.
34. Rauso R, Sesenna E, Fragola R, et al. Skin necrosis and vision loss or impairment after facial filler injection. J Craniofac Surg, 2020, 31(8): 2289-2293.
35. Goodman GJ, Magnusson MR, Callan P, et al. A consensus on minimizing the risk of hyaluronic acid embolic visual loss and suggestions for immediate bedside management. Aesthet Surg J, 2020, 40(9): 1009-1021.
36. Tansatit T, Jitaree B, Uruwan S, et al. Anatomical study of the dorsal nasal artery to prevent visual complications during dorsal nasal augmentation. Plast Reconstr Surg Glob Open, 2021, 9(11): e3924.
37. Lee W, Moon HJ, Kim JS, et al. Safe glabellar wrinkle correction with soft tissue filler using doppler ultrasound. Aesthet Surg J, 2021, 41(9): 1081-1089.

West China Medical Journal

Filling injection in facial danger area and related vascular complications

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