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Jun 28, 2023
Dermal fillers have gained popularity as a non-surgical cosmetic option for facial rejuvenation. However, it is not without a certain level of danger, as there is a possibility that certain complications arise. One of them is vascular occlusion.
What is vascular occlusion, and how is it exactly linked to dermal filler injections? That’s the topic we’re set to explore today, including the signs and symptoms to watch for, preventive measures, and the importance of prompt intervention. By raising awareness of this potential risk, we aim to enhance safety and promote informed decision-making in the realm of cosmetic procedures involving dermal fillers.
What is a Vascular Occlusion?
Vascular occlusion refers to the blockage or obstruction of blood vessels, typically arteries or veins, that restricts or cuts off blood flow to a specific area of the body. It can occur in various parts of the body, including the brain, heart, limbs, and organs.
There are two main types of vascular occlusion:
1. Arterial occlusion: This occurs when an artery supplying oxygenated blood to a specific region becomes blocked. Arterial occlusion can be caused by the formation of a blood clot, atherosclerosis (build-up of fatty deposits in the artery walls), arterial spasms, or compression of the artery by external factors. The lack of blood flow can lead to tissue damage or cell death due to the deprivation of oxygen and nutrients.
2. Venous occlusion: This happens when a vein carrying deoxygenated blood back to the heart becomes obstructed. Venous occlusion can be caused by blood clots (thrombosis occlusion), inflammation, or vein compression. This can cause blood pooling in the affected area, leading to swelling, pain, and potential complications.
Vascular occlusion can occur when the injected filler inadvertently enters a blood vessel, leading to blockage or reduced blood flow in that vessel. This can cause tissue ischemia (lack of blood supply) and potential tissue damage. The risk of vascular occlusion is higher when dermal fillers are injected into areas with dense blood vessel networks, such as the nose, forehead, or glabella (between the eyebrows).
How Common is Vascular Occlusion?
Vascular occlusion is considered a relatively rare but serious complication associated with dermal filler injections. While the exact prevalence rate is challenging to determine, studies and case reports have provided insights into the occurrence and associated risks.
Several factors contribute to the rarity of vascular occlusion from filler procedures. First, healthcare professionals who perform these injections are typically trained to follow proper injection techniques and have knowledge of facial anatomy, which helps minimize the risk. Additionally, advances in product formulations and injection practices have contributed to improved safety.
The reported prevalence of vascular occlusion varies across studies, ranging from less than 1% to around 2-4% of cases. It’s important to note that these figures are approximate and may not capture the true extent of this health issue due to under-reporting or lack of standardized reporting mechanisms.
Certain factors can increase the risk of vascular occlusion. Injection in high-risk areas, such as the glabella, nasolabial folds, or tear troughs, where blood vessels are densely distributed, may increase the chances of occlusion. Using larger-gauge needles, excessive filler volumes, and inappropriate injection techniques can also contribute to the risk.
Prompt recognition and appropriate management are crucial in minimizing the risk of a blocked blood vessel after filler. Healthcare professionals should be vigilant in identifying early signs, such as severe pain, skin discoloration, or skin necrosis, and take immediate action. This may involve discontinuing the injection, administering hyaluronidase to dissolve the filler, or employing other measures to restore blood flow.
Ongoing education and training for healthcare professionals performing dermal filler injections remain vital in enhancing patient safety. Regulatory bodies and professional organizations provide guidelines and recommendations to ensure safe practices and raise awareness of potential risks.
While vascular occlusion remains relatively rare, understanding its prevalence and associated factors can help healthcare professionals and patients make informed decisions, adopt preventive measures, and facilitate early intervention if necessary.
Signs of a Vascular Occlusion
Recognizing vascular occlusion symptoms after dermal filler injections is crucial for prompt intervention and management. If your patients experience any of the common symptoms, they should immediately report them and start the treatment.
These are all signs of a vascular occlusion:
- Severe or persistent pain
- Skin discoloration or blanching (bluish tint)
- Skin necrosis
- The coolness of the skin
- Delayed or non-healing wounds
- Vision changes or partial vision loss
Although these symptoms can also be associated with other conditions following dermal filler injections, they should raise suspicion of vascular occlusion. Early intervention and detection of symptoms of vascular occlusion mitigate potential complications and improve outcomes.
Injection Areas to Avoid
To minimize the risk of vascular occlusion when administering dermal fillers, avoiding injecting in areas with a high density of blood vessels is essential. Below are some areas that should be approached with caution or avoided altogether, as well as advice on techniques to provide the safest dermal filler treatment possible.
- Glabella: The area between the eyebrows (glabella) and the forehead has a rich blood supply, including the supratrochlear and supraorbital arteries. Injecting dermal fillers in this region carries a higher risk of vascular occlusion. Micro-droplet and fanning techniques are highly advised.
- Nasolabial folds: These lines run from the sides of the nose to the corners of the mouth. This area has a dense network of blood vessels, including branches from the facial artery.
- Nose: The nose has a complex vascular anatomy, including the dorsal nasal artery and angular artery. Injection techniques, such as threading or retrograde injections, may minimize the risk.
- Tear troughs: Positioned beneath the lower eyelids, this area is delicate and close to important blood vessels, such as the infraorbital artery.
- Lips: The lips have a rich blood supply from various arteries, including the labial artery. Precise injection techniques, avoiding blood vessels, and using small amounts of filler can help reduce the risk of lip filler vascular occlusion.
Vascular Occlusion Prevention
Preventing vascular occlusion during dermal filler injections involves several key methods and precautions.
An in-depth understanding of facial anatomy is essential to identify the location and course of blood vessels. Familiarity with the vascular anatomy of the injection sites and the patient’s history of medical conditions helps avoid direct vessel puncture and minimize the risk of occlusion.
We’ve touched upon injection techniques in the previous section, like micro-droplet and fanning. They both involve injecting small amounts of filler at a time, leading to better control of the procedure and, in turn, reducing the likelihood of vessel penetration and causing vascular occlusion with the filler material. This is especially important when administering fillers in areas with dense vascular supply.
Have hyaluronidase, an enzyme that can dissolve hyaluronic acid fillers, readily available. Prompt administration of hyaluronidase can help reverse vascular occlusion by dissolving the filler material and restoring blood flow.
Lastly, explaining proper filler aftercare to your patient, as well as scheduling regular checkups, is important as a way of preventing and monitoring the occurrence of vascular occlusions.
By implementing these preventive measures, healthcare professionals can minimize the risk of vascular occlusion during dermal filler injections and enhance patient safety.
While the occurrence of vascular occlusion following dermal filler injections is relatively rare, the potential risks highlight the importance of qualified and experienced healthcare professionals performing these procedures. Patient safety should always be the primary concern, and adherence to safe injection practices and continuous professional training are essential.
Recognizing the first signs and symptoms is crucial for early intervention and protecting your patient’s health. Of course, knowing the best methods for preventing vascular occlusion in lip fillers and similar treatments can ensure that dermal filler procedures provide the optimal outcome.
A Treatment Protocol for Vascular Occlusion from Particulate Soft Tissue Augmentation; Kenneth Beer (MD), Jeanine Downie (MD), and Jacob Beer; May 2012
Management of a Vascular Occlusion Associated with Cosmetic Injections; Martyn King (MD), Lee Walker (DDS), Cormac Convery (MD), Emma Davies (RN, NMP); Jan 2020
Rates of Vascular Occlusion Associated With Using Needles vs Cannulas for Filler Injection; Murad Alam, Rohit Kakar, Jeffrey S. Dover; Dec 2020
Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials; E. Vargas-Laguna, J. García-Gavín, E. Bárcena-Ruiz; Jul 2021
What are the signs of vascular occlusion?
The most obvious signs of vascular occlusion after filler are pain, swelling, and changes to the skin color.
Can vascular occlusion heal on its own?
No, and it’s highly recommended to remedy this issue immediately. Gently massaging the skin, applying heat, and off-the-counter blood thinning medication are some of the most effective ways to treat vascular occlusion.
What causes occlusion of blood vessels?
A blood clot or improper administration of dermal fillers can lead to occlusion of blood vessels.