title: Skin Necrosis of the Nose After Injection of Ribose Cross-Linked Porcine Atelocollagen.
abstract: We report a case of skin necrosis of the nasal tip after an injection of ribose cross-linked porcine atelocollagen (Evolence; Colbar Life Science Ltd, Herzliya, Israel). A 22-year-old woman had a nasal augmentation. From the glabella to the nasal tip, 10 strokes were injected using 0.6 mL of Evolence. On the day of the injection, her nasal tip became cyanotic; a day after it, an erythematous condition developed and a white cheeselike material appeared. On the second day, it became necrotic. Epithelialization was completed for 2 weeks. Despite laser therapy, permanent scarring of the nasal tip was prominent at the 18-month follow-up. It was thought that the skin necrosis is caused by vascular interruption rather than by hypersensitivity because the skin necrosis was confined to the nasal tip. To avoid vascular interruption from a filler injection, aspiration is needed before injection. The least amount of filler should be released in each stroke with low-pressure injection.
authors.affiliation: *Dr Kim's Aesthetic Surgical Plastic Clinic, Seoul †Department of Plastic Surgery, Inha University School of Medicine, Incheon, Republic of Korea.
authors.forename: Seong Kee
authors.initials: SK
authors.lastname: Kim
authors.forename: Joo Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Kun
authors.initials: K
authors.lastname: Hwang
mesh_terms: D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D003094:Collagen / Q000009:adverse effects* / Q000737:chemistry; D003357:Cosmetic Techniques / Q000009:adverse effects*; D003432:Cross-Linking Reagents / Q000737:chemistry; D003490:Cyanosis / Q000209:etiology; D000067548:Dermal Fillers / Q000009:adverse effects* / Q000737:chemistry; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections / Q000009:adverse effects; D053685:Laser Therapy; D009336:Necrosis; D009666:Nose / Q000473:pathology*; D062326:Re-Epithelialization / Q000502:physiology; D012266:Ribose / Q000737:chemistry; D012867:Skin / Q000473:pathology*; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D000067548:Dermal Fillers; C549013:dermicol-P35 27G; D012266:Ribose; D003094:Collagen