Rethinking the Role of Nitroglycerin Ointment in Ischemic Vascular Filler Complications: An Animal Model With ICG Imaging

Ophthalmic Plastic and Reconstructive Surgery
Catherine J HwangGary Duckwiler

Abstract

Soft tissue dermal fillers, both temporary and permanent, are used frequently in facial rejuvenation. As the use of fillers increases, ischemic complications including skin necrosis are becoming more prevalent. In the literature, topical nitroglycerin paste has been recommended in the early treatment of patients presenting with ischemia. The purpose of this study was to evaluate the vascular perfusion effects of topical nitroglycerin paste in an animal model using indocyanine green (ICG) imaging. After Animal Research Committee approval, a rabbit ear model was used to create filler-associated skin ischemia. Ischemia was confirmed to occur after intra-arterial occlusion. Four commonly used soft tissue fillers were injected intra-arterially: Radiesse (Merz USA, Greensboro NC), Restylane (Galderma, Ft. Worth, TX), Juvederm Ultra (Allergan, Irvine CA), Belotero (Merz USA, Greensboro NC) (0.1 ml). A total of 15 ears were used, 1 control and 4 experimental per product. Thirty minutes after occlusion, nitroglycerin ointment USP, 2%(Nitro-Bid) was applied topically to the experimental ears. Vascular perfusion was evaluated with the SPY System (Novadaq Inc.) using ICG imaging. Perfusion images were obtained at baseline, immediately afte...Continue Reading

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Citations

Jul 12, 2016·Journal of Cutaneous and Aesthetic Surgery·Catherine J Hwang
Apr 28, 2017·Journal of the European Academy of Dermatology and Venereology : JEADV·W G Philipp-DormstonK Fritz
Jan 9, 2018·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Monique J Vanaman WilsonSabrina G Fabi
Jan 19, 2019·Plastic and Reconstructive Surgery. Global Open·Philippe Snozzi, Jani A J van Loghem
Mar 9, 2018·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Steven Fagien, Jean Carruthers
Nov 13, 2019·Journal of Cosmetic Dermatology·Aleksandra L Lindgren, Kathleen M Welsh
Jul 30, 2019·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Sama K CarleyJoel L Cohen
Mar 19, 2020·Journal of Cosmetic Dermatology·Jani van LoghemPeerooz Saeed
Dec 23, 2020·Aesthetic Surgery Journal·Ryan M MooreGregory R D Evans
Feb 6, 2021·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Derek H JonesMurad Alam

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