Henderson Raven, Reilly Debra A, Cooper Jeffrey S
Division of Plastic & Reconstructive Surgery, University of Nebraska Medical Center, Omaha, Neb.; and Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Neb.
Plast Reconstr Surg Glob Open. 2018 Jan 11;6(1):e1618. doi: 10.1097/GOX.0000000000001618. eCollection 2018 Jan.
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.
天然和合成填充剂彻底改变了面部美容年轻化和软组织填充。我们报告一例突出填充剂自我注射危险的病例。一名37岁女性在双侧颞部自我注射了一种真皮填充剂。她立即出现左侧听力丧失、左侧面部皮肤变白和疼痛。随即用透明质酸酶、外用硝酸酯糊剂和热敷进行了及时治疗。急诊计算机断层血管造影显示颞浅动脉分支闭塞。我们用依诺肝素、阿司匹林、地塞米松、哌拉西林-他唑巴坦和皮内利多卡因对她进行治疗。在3天内进行6次高压氧治疗（HBO2）后，患者外观有所改善，缺血性变色明显减轻，听力恢复到基线水平。治疗此类损伤的算法通常忽略了HBO2。人们认为HBO2在这些情况下通过多种机制有效：使缺血组织氧合、减轻水肿、改善缺血/再灌注损伤、促进血管生成和胶原蛋白成熟。她听力的恢复也凸显了HBO2在突发性听力丧失中的作用。注射者应该有使用产品的指南，不仅针对患者，也针对工作人员。填充剂课程应该包括处理并发症，并在其指南中纳入HBO2。临床医生应该提醒患者向合格的临床医生寻求治疗。通过自我注射追求低价的目标可能很快变得代价高昂且导致容貌毁损。
