Experience and Management of Intravascular Injection with Facial Fillers: Results of a Multinational Survey of Experienced Injectors.
BACKGROUND
Intravascular injection leading to skin necrosis or blindness is the most serious complication of facial injection with fillers. It may be underreported and the outcome of cases are unclear. Early recognitions of the symptoms and signs may facilitate prompt treatment if it does occur avoiding the potential sequelae of intravascular injection.


OBJECTIVE
To determine the frequency of intravascular injection among experienced injectors, the outcomes of these intravascular events, and the management strategies.


METHODS
An internet-based survey was sent to 127 injectors worldwide who act as trainers for dermal fillers globally.


RESULTS
Of the 52 respondents from 16 countries, 71 % had ≥11 years of injection experience, and 62 % reported one or more intravascular injections. The most frequent initial signs were minor livedo (63 % of cases), pallor (41 %), and symptoms of pain (37 %). Mildness/absence of pain was a feature of 47 % of events. Hyaluronidase (5 to >500 U) was used immediately on diagnosis to treat 86 % of cases. The most commonly affected areas were the nasolabial fold and nose (39 % each). Of all the cases, only 7 % suffered moderate scarring requiring surface treatments. Uneventful healing was the usual outcome, with 86 % being resolved within 14 days.


CONCLUSIONS
Intravascular injection with fillers can occur even at the hands of experienced injectors. It may not be always associated with immediate pain or other classical symptoms and signs. Prompt effective management leads to favorable outcomes, and will prevent catastrophic consequences such as skin necrosis. Intravascular injection leading to blindness may not be salvageable and needs further study.


METHODS
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Skin and Cancer Foundation Inc. and Monash University, Wellington Rd, Clayton, VIC, 3168, Australia. jacqui@div.net.au.
Greg J
GJ
Goodman
Dermatology Institute of Victoria, South Yarra, Australia.
Stefania
S
Roberts
Private Practice, Geelong, VIC, Australia.
Peter
P
Callan
D001315:Australia; D002983:Clinical Competence; D003357:Cosmetic Techniques; D003430:Cross-Sectional Studies; D000067548:Dermal Fillers / Q000008:administration & dosage* / Q000009:adverse effects; D004954:Esthetics; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D060052:Nasolabial Fold; D012060:Rejuvenation / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000067548:Dermal Fillers; D006820:Hyaluronic Acid
Complication; Fillers; Intravascular injection; Skin necrosis