PRIME North America Vol.5 Issue 6

AVOIDING INTRA-VASCULAR COMPLICATIONS AFTER FILLER INJECTION ABSTRACT The face is a highly vascularized area and there are six danger zones mentioned in the literature that should be approached with caution. Any injection in these areas should be administered carefully. In this article, we present an innovative way tomark the danger zone areas before administering the filler injection using a hand-held Doppler ultrasound system. S URGICAL FACIAL REJUVENATION IS GRADUALLY BEING replaced with non-surgical modalities, especially fillers (artificial or autologous). The popularity of non-surgical procedures is increasing day-by-day 1 . They are, however, associated with certain potential complications, ranging fromminimal bruising on one end of the scale to blindness on the other 2,3 . There are multiple guidelines to be observed while injecting any filler to avoid intra-vascular complications. These include slow injection, blunt needles/cannulas, and regular withdrawal of the plunger before injecting. The face is one of the most highly vascularized areas of the body, supplied by vessels from both the external and carotid arteries. There are rich anastomoses among the vessels of both the systems. The literature mentions ‘six’ distinct places deemed as ‘facial danger zones’ where the anastomoses are found 4,5 . These ‘danger zones’ pose a higher risk of potentially devastating adverse events. These include the: ■ ■ Glabella area (supraorbital and supratrochlear arteries) ■ ■ Nasal area (angular artery) ■ ■ Nasolabial groove (facial artery) ■ ■ Tear trough (infraorbital artery) ■ ■ Temples (superficial temporal artery) ■ ■ Lips/commissures (labial arteries) 4,5 . Anatomical considerations An extensive knowledge of anatomical variations is essential while undertaking filler injections to the face, especially around these ‘danger zones.’ KEYWORDS Filler injections, intravascular, Doppler MUHAMMAD HUMAYUN MOHMAND, MD, Cosmetic, Plastic & Hair Restorative Surgeon; MUHAMMAD AHMAD, MD, Plastic & Hair Restorative Surgeon; ARMEELA JAVAID, MD, Consultant Dermatologist, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan email DrsMuhammadHumayunMohmand,MuhammadAhmad, and Armeela Javaid demonstratean innovativeway toavoid injecting filler material intobloodvessels CASE STUDY | DOPPLER & INTRAVASCULAR FILLER INJECTION | 30 November/December 2017 |