Lima Vanessa Guimaraes de Freitas, Regattieri Neysa Aparecida Tinoco, Pompeu Marcelo Faro, Costa Izelda Maria Carvalho
Hospital Universitário de Brasilia, Universidade Federal de Brasília, Brasília, Brazil.
J Cosmet Dermatol. 2019 Dec;18(6):1629-1631. doi: 10.1111/jocd.12901. Epub 2019 Mar 5.
We present a case report of a hyaluronic acid filler-induced complication documented using high-frequency ultrasound. We regard the scientific value of the case as indicating the benefit that ultrasound provides for the management and documentation of this complication. This technology has been becoming increasingly widespread in the care of patients who experience unwanted effects of hyaluronic acid filler because it can be used for the high-resolution visualization of skin layers as well as the differentiation of filler types and their relationships with adjacent tissues (via gray scale or B-mode ultrasound) and blood vessels (via color Doppler ultrasound). In addition, it was possible to conclude that external vascular compression causes clinical repercussions, a fact that is often questioned by some dermatologists. This questioning is based on the vast vascularization and anastomosis of arteries of the face, which should permit compensation for vascular compression. However, in this case, there was no doubt that compression caused a region of low output with the clinical manifestation of peri-oral pallor. Ultrasound was used to document the compression of a vessel by the filler; after application of hyaluronidase, increased vessel lumen and clinical reversal of hypoperfusion in the affected area were observed.
我们报告一例使用高频超声记录的透明质酸填充剂引起的并发症。我们认为该病例的科学价值在于表明超声在这种并发症的管理和记录方面所具有的优势。这项技术在治疗因透明质酸填充剂产生不良影响的患者中越来越普遍，因为它可用于皮肤层的高分辨率可视化，以及填充剂类型的鉴别及其与相邻组织（通过灰阶或B型超声）和血管（通过彩色多普勒超声）的关系。此外，有可能得出外部血管受压会产生临床影响的结论，这一事实常受到一些皮肤科医生的质疑。这种质疑基于面部动脉丰富的血管化和吻合，这应该能补偿血管受压。然而，在这个病例中，毫无疑问受压导致了低输出区域，并出现口周苍白的临床表现。超声用于记录填充剂对血管的压迫；注射透明质酸酶后，观察到血管腔增大以及受影响区域灌注不足的临床症状得到缓解。
