Hi everyone, I was reading up on the risks involved when injecting filler and I was freaked out to see that skin necrosis is a complication. I have a few questions about this!

First of all, how "rare" (or not) is this event, how do you know if it has happened? Can they stop it from getting too serious (and disfiguring) if it does? Can this happen to any Dr (even the most skilled), and where are the riskiest places for this to happen? (lips, cheeks, nasal folds, etc) Also, are you at greater risk if you have low blood pressure (I have very low blood pressure).


Thanks for all your great knowledge!

Laura

I'm seeing two types of problems. One is with collagen or other injections in the glabella, and the other is with hyaluronic acid in the alar region, mostly on patients with a history of procedures on the nose and pre-compromised vascularity. The hyaluronic acid is thought to swell and partially block the nearby arteries. But some other types of fillers have been mentioned as well.

They can usually catch this and treat to prevent noticeable scarring. They use nitroglycerin paste, hyaluronidase (if appropriate), antibiotics, and sometimes hyperbaric oxygen.

I haven't read anything about low blood pressure being a risk but it seems to me that diabetics and people with a history of cardiovascular disease would be in the higher risk group.

Either way, it's very rare, with only a handful of reported cases. And that's for 1.5 million hyaluronic injection events.

Be sure to provide your doctor with your complete surgical history, and it may also be helpful when going to your next injector, to provide a diagram of your previous injection sites.

This is extremely interesting to me. I had bio-alcamid injected in my cheeks 4 years ago, aside from the disfiguration it caused, I experienced a surge of broken blood vessels...horrible blue coloured skin...definitely not genetic, as I'm of Eastern European descent.

Please, please...if I can shed one bit of advise - do not inject filler into your face. And if you must...opt for a temporary filler - NEVER let a surgeon use a "permanent filler"...whilst these are often marketed as removable, they truly are not....my face has been destroyed by this garbage.

Can you provide a link to the paper please? I have not been able to find it. This is timely for me as I have recently been considering Aquamid as I have poor retention with temporary fillers. Your post has made my mind up for me. It is not worth the risk.
Thanks so much

Sarah W, I can email you what I have if you pm me with an address. Knowing what I know I would opt against any permanent filler. I haven't ruled out Sculptra, fat, or hyaluronic acid yet, though.

Revolver, I am considering Sculptra and hyaluronic acid myself. Each filler is a calculated risk, and there are things that can be done to minimize the risks. I will have to go to a few more consults to decide. With Sculptra the injection depth (deep), technique, dilution (some recs have changed to 8-12 mls of water now up from the original 5), and time from reconstitution (at least 24 and preferably up to 72 hrs) are all important. I recently spoke with a doctor who said he has never had a problem with it, not even under the eyes, he loves it because he can control it better than hyaluronics or fat. Previously I spoke with another doctor who thought all fillers were a stupid waste of time.

I think they like/promote what they are good at and what they know. But what's best for you might be different. I am skeptical about getting the best possible recommendations from anyone who is not equally adept with all them. So I plan on a couple more consultations, I want to compare their recs, before I decide.

The hyaluronic acid fillers look to be safest, incidence of nodules is very low, about 0.01-0.1% and they usually go away with antibiotics or hyaluronidase. The earliest batches had more contaminated protein but the latest batches are much more pure and incidence of problems is a lot lower.

The necrosis problem is usually when they try to inject too much into a place that already has compromised vascularity, if you have had multiple nose jobs just say no to that area.

The least safe places aside from that are the middle of the forehead and the under eye area, make sure you get a very experienced injector for under the eyes.

I am signed up for 5 vials of juvederm in early April. Its cross-liking agent, 1,4-butanediol diglycidyl ether (BDDE) is at less than 2 parts per million. This is considered to be safe level.

Don't do anything rash birdy. You're under a Dr.'s care and the hospital is only a possibility IF it's an infection- it might not be,. Might be as he said- an imflamatory reaction and antibiotics aren't going to help with that. This was the LAST post you needed to see. Please get off the internet looking up horror stories about this,they are few and far between, and reading them is only going to upset you further. Wait until tomorrow and see if it gets better. Call me tomorrow morning if you can and I'll be praying for you to have a full and speedy recovery from this. You're going to be OK.

I am certainly no doctor, but I got a small patch of necrosis on my SHIN from a sclerotherapy injection done years ago. Now that was pretty much just saline solution back then, but even so, the needle missed its mark, and the solution was injected into my skin right under the surface. The necrosis wasn't painful or fatal. But it was a stubborn patch of dark purple, almost scaly-looking skin about the size of a dime.

That spot took easily a year to fade away, and many months after I still had it, I was in to see my PS for the facelift stuff. He noticed the spot and suggested I put some Bacitracin on it. Believe it or not, that's what faded the spot away. I can not even tell where it was on my shin.

I never thought any more about it, and I don't even know what the necrosis was caused by - but Kosmeds brings up an intriguing point: overinjecting an area with compromised vascularity. That could definitely be the case.

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I Bug U

Usually nasolabial is not a problem, but the very few problems that have occurred from hyaluronics are mostly in people who have a tendency to form keloids where the injection is too superficial. If keloids do occur, steroid injection usually resolves them. If granulomas occur from superficial injection of hyaluronics, they usually resolve on their own within a year or sooner if they are drained. Ref for this is: Lemperle at al, Avoiding and Treating Dermal
Filler Complications, Plastic and Reconstructive Surgery, September 1 Supplement, 2006

Another problem but much less of a problem is the previously discussed (elsewhere) Tyndall effect, which is a bluish show-through if the injection is too superficial. This is usually treated with hyaluronidase.

If compressed vascularization is suspect, a quick injection of hyaluronidase can solve the problem before it progresses. The risk is greater if a larger volume of filler is used or if the filler is placed in a
tight space.