We are going to talk about the prevention of intravascular complications related to fillers.
The worst complication that you may encounter is blindness. If you want to prevent it from happening you need to understand two things, anatomy, and tools. You need to understand how is the anatomy of the vessels, both arteries, and veins. First of all, we will classify blindness post filler injection.
Type 1 blindness: Although the patient had blindness and skin necrosis on the nose, ptosis was absent and eyeball movement was possible in every direction.
Type 2 blindness: The patient, a 41 years old woman, was diagnosed with left central retinal artery occlusion. Along with blindness, the patient had ptosis of the left eye and no accompanying limitation on eyeball movement.
Type 3 blindness: the patient, a 26 years old woman, was diagnosed with right central retinal artery occlusion. Along with blindness, the patient had eyeball movement limitation without ptosis of the affected eye.
Type 4 blindness: The patient, a 31 years old woman, was diagnosed with left central artery occlusion. The patient demonstrated movement limitation of both eyeballs and ptosis of the left eye.
Recently, there was a higher reported case of intravascular injections because of:
- An increasing number of filler injections. In 2014 only, 5.5 million injections were performed worldwide.
- The transition from the trend of 2D voluminisation to 3D approach.
- Larger volume placement in deeper planes leading to an increased risk of vessel block
Mechanism of blindness secondary to soft tissue augmentation is associated with intravascular injection and retrograde embolization. To prevent this from happening you need to have a smaller gauge needle, slow injection speed, and low volume bolus.
The facial danger zones are:
- Glabella
- Temple
- Nose
- Perioral area (Lips)
- Infraorbital region
- Nasolabial fold
Glabella arteries are initially deep, but become superficial about an inch above so you should use a low G prime filler and use a finger on the orbital rim to prevent backflow into the orbit.
Given the shallow nature of the vasculature within the nose, a misplaced injection can lead to disastrous results, such as tip and alar necrosis, ocular ischemia, and blindness. So injecting the nose after rhinoplasty is not recommended. The safe injection plane is the avascular supraperiosteal deep plane on the nose.
The other areas of the face will be discussed in detail and we will teach you where and how you should inject to avoid intravascular complications.
