Hong Gi-Woong, Hu Hyewon, Chang Kathleen, Park Youngjin, Lee Kar Wai Alvin, Chan Lisa Kwin Wah, Yi Kyu-Ho
Samskin Plastic Surgery Clinic, Seoul 06577, Republic of Korea.
Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Diagnostics (Basel). 2024 Jul 18;14(14):1555. doi: 10.3390/diagnostics14141555.
Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.
真皮填充剂治疗引发的血管并发症带来重大风险，包括局部缺血、组织坏死以及失明和肺栓塞等严重后果。本研究调查血管并发症的机制，将其分为血管外压迫和血管内栓塞。当注射的填充剂压迫相邻血管时会发生血管外压迫，导致局部缺血和潜在坏死，而血管内栓塞则是由于填充剂进入血管导致堵塞。该研究强调了解剖学知识、谨慎的注射技术和早期干预的重要性。管理策略包括使用透明质酸酶溶解透明质酸填充剂、使用血管扩张剂改善血液循环以及高压氧治疗。最易发生并发症的区域与主要动脉路径一致，特别是鼻唇沟和鼻部区域。该研究还强调了需要精细的注射技术、在高风险区域使用套管而非针头以及进行回抽试验以检测是否穿透血管。早期发现和立即干预对于减轻不良后果至关重要。对从业者进行持续教育和培训，以及填充材料和注射方法的进步，对于提高美容手术的安全性至关重要。这种全面的认识有助于预防和管理血管并发症，确保更好的患者预后。真皮填充剂治疗领域正随着新技术和新科技不断发展，如高分辨率超声、红外成像、自交联透明质酸填充剂、可生物降解微球和微注射技术。
