Hyperbaric Oxygen for Ischemia due to Injection of Cosmetic Fillers: Case Report and Issues

Plastic and Reconstructive Surgery. Global Open
Raven HendersonJeffrey S Cooper

Abstract

Natural and synthetic fillers have revolutionized aesthetic facial rejuvenation and soft-tissue augmentation. We present a case highlighting the dangers of filler self-injection. A 37-year-old woman self-injected a dermal filler around both temples. She immediately experienced left--side hearing loss, blanching over the left face, and pain. Prompt treatment with hyaluronidase, topical nitro paste, and warm compresses ensued. An emergency computed tomography angiogram showed occlusion of a superficial temporal artery branch. We treated her with enoxaparin, aspirin, dexamethasone, piperacillin-tazobactam, and intradermal lidocaine. After 6 hyperbaric oxygen therapy (HBO2) treatments in 3 days, the patient showed improvement in appearance with markedly decreased ischemic discoloration and her hearing returned to baseline. Algorithms for treating such injuries generally neglect HBO2. HBO2 is thought to be efficacious in these situations by a variety of mechanisms: oxygenation of ischemic tissues, reduction of edema, amelioration of ischemic/reperfusion injury, promotion of angiogenesis and collagen maturation. Her resolved hearing highlights the utility of HBO2 in sudden hearing loss as well. Injectors should have guidelines for us...Continue Reading

References

Jul 6, 2010·Aesthetic Surgery Journal·Shimpei Ono, Hiko Hyakusoku
Jan 14, 2011·Plastic and Reconstructive Surgery·Stephen R Thom
Aug 1, 2014·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Melissa D DarlingSabrina G Fabi
Jun 18, 2015·American Journal of Clinical Dermatology·Annelyse Cristine BallinAlex Cazzaniga

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Citations

Mar 19, 2020·Journal of Cosmetic Dermatology·Jani van LoghemPeerooz Saeed
Jul 11, 2020·Journal of Cosmetic Dermatology·Assaf ZeltzerMoustapha Hamdi
Aug 30, 2019·Archives of Craniofacial Surgery·Woo Taik HongSug Won Kim
Dec 23, 2020·Aesthetic Surgery Journal·Ryan M MooreGregory R D Evans
Dec 29, 2020·Facial Plastic Surgery : FPS·Akina TamakiEnver Ozer

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