The Role of Anastomotic Vessels in Controlling Tissue Viability and Defining Tissue Necrosis with Special Reference to Complications following Injection of Hyaluronic Acid Fillers

There is no such thing as risk free cosmetic surgery.

Every cosmetic procedure including the “non-surgical” injectables have risk. Soft tissue death and blindness are well documented complications of soft tissue filler injections.

Beware of the training of your injector. Do your homework. Some injectors are well trained and know how to minimise risk, others simply don’t.

Skype consultations are not in the best interest of the patient. They do not allow a full explanation of risk or nuance of the treatment required. The doctor is remote from the patient and is therefore unable to treat complications should they arise. Using Skype consultations in shopping centres to prescribe Botox and Fillers is simply designed to maximise profits and is not ethical complete patient care.

I am an expert in this field, both in the aetiology of the blindness and soft tissue necrosis. I am frequently asked to comment on the complications, because I care deeply about empowering patients with the right information.

If you want to dive deeper into the risks, you can read more in this journal article, one of many, I have published on the issue.

Mark

The Role of Anastomotic Vessels in Controlling Tissue Viability and Defining Tissue Necrosis with Special Reference to Complications following Injection of Hyaluronic Acid Fillers

Ashton, Mark W. F.R.A.C.S.; Taylor, G. Ian A.O., F.R.A.C.S.; Corlett, Russell J. F.R.A.C.S.

Plastic and Reconstructive Surgery: June 2018 – Volume 141 – Issue 6 – p 818e-830e
doi: 10.1097/PRS.0000000000004287
Cosmetic: Original Articles
 
ABSTRACT:

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Background: Most target areas for facial volumization procedures relate to the anatomical location of the facial or ophthalmic artery. Occasionally, inadvertent injection of hyaluronic acid filler into the arterial circulation occurs and, unrecognized, is irreparably associated with disastrous vascular complications. Of note, the site of complications, irrespective of the injection site, is similar, and falls into only five areas of the face, all within the functional angiosome of the facial or ophthalmic artery.

Methods: Retrospective and prospective studies were performed to assess the site and behavior of anastomotic vessels connecting the angiosomes of the face and their possible involvement in the pathogenesis of tissue necrosis. In vivo studies of pig and rabbit, and archival human total body and prospective selective lead oxide injections of the head and neck, were analyzed. Results were compared with documented patterns of necrosis following inadvertent hyaluronic acid intraarterial or intravenous injection.

Results: Studies showed that the location of true and choke anastomoses connecting the facial artery with neighboring angiosomes predicted the tissue at risk of necrosis following inadvertent intraarterial hyaluronic acid injection.

Conclusion: Complications related to hyaluronic acid injections are intimately associated with (1) the anatomical distribution of true and choke anastomoses connecting the facial artery to neighboring ophthalmic and maxillary angiosomes where choke vessels define the boundary of necrosis of an involved artery but true anastomoses allow free passage to a remote site; or possibly (2) retrograde perfusion of hyaluronic acid into avalvular facial veins, especially in the periorbital region, and thereby the ophthalmic vein, cavernous sinus, and brain.

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