Vascular Complications After Nose Filler Injection
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| Circulation problem on the nose that occurs after cross-linked hyaluronic acid filler injection. Photographs taken on days 1-8 and 13, respectively. After the treatment, it is seen that the symptoms gradually decrease and become close to normal. |
Filler injection to the nose is a very simple procedure that can be done in office conditions. When the correct application technique and safe products are used, the risk and complications of non-srugical nose job are very low.
Generally, the most used and most reliable products in nose filler procedures are filling materials containing hyaluronic acid. About 1 month ago, a patient who developed skin discoloration, pus flowing areas on the nose after cross-linked hyaluronic acid filler injection in another clink, followed by bruising complaints applied to our clinic. The above photographs show the photographs taken immediately after the injection of elephants into the nose and then taken every day until the 8th day, and finally the photograph taken on the 13th day.
It has been learned that the filler injected into the fault is a CE certified and quality product. When paying attention to the area with color change on the nose that appeared on the first day of the patient, it is seen that the infection with inflamed areas is added within a few days after the lesion starts in the form of a sharp line in the form of a bruise.
In the foreground, the patient was diagnosed with circulatory disorder and skin infection due to the injection of elephants and the following protocol was followed:
- Use of ciprofloxacin derivative antibiotic tablets
- Putting the towel soaked in water heated to about 60 degrees on the nose for a few minutes and taking a break for a few minutes.
- Cialis 20 mg tablet, one tablet a day (this product may effect response is to increase blood flow on the nose and it may cause to flushing as side effect but its mean increase the blood circulation)
- While hyaluronidase enzyme injection was planned as soon as possible, it was not performed due to the normalization of the skin color in the follow-up of the patient.
- Hyperbaric oxygen treatment was not planned, as the patient did not form a nexrosis line and gradually improved healing properties.
Factors that increase the risk of circulatory disorders in the nose after nose filler injection
- Planning the nose filler procedure for patients who have previously had various filling reactions or similar problems (even if the elephant material is not injected into the vein during the elephant injection; it may cause a decrease in capillary circulation due to the mass effect and pressure, therefore, in noses with circulation problems already. avoiding this process is ideal)
- Injection of large amounts of filler substance (usually injecting a very small part of the filller injector at the first time, I prefer to do it 2 or 3 times a month on average every 2 weeks. Fillers containing cross-linked hyaluronic acid are the most preferred all over the world. Generally, once a single product is opened, an application is made every 2 weeks. The most accurate application is to do it little by little and evaluate the patient herself at the same time with the hand mirror. If the injector is not finished, the patient comes 3 times in 1 month, and if the injector runs out for the second time, it comes twice in total. This triple application is healthier and can extend the duration of action).
- Using products with quality and purity problems. It is inconvenient to use non-bandro-based products from the Far East and the European Quality Standards Regulation (CE) of uncertain purity. There are semi-permanent and permanent fillers, both the price and the risk increase, patients generally prefer hyaluronic acid and decide whether they are satisfied with the filler or not and see the result.
How to understand if circulatory disorders occur during non-surgical nose job?
Especially in patients with recurrent nasal operations, the risk of circulatory disorders in the nose may be higher and it may be appropriate to avoid a large amount of filler injection at the first time by choosing a thick needle.
There is no tissue loss and color change on the patients's nose currently and I am very happy with this situation.
Another Patient Example with Necrosis and Infection in the Nose After Non-surgical Rhnoplasty With Filler Procedure
Photograph No. 1: The dark and red area surrounded by a white border that emerged after the filler injection is seen outside the nose wing and towards the cheek. Unfortunately, this area is not very suitable for filler injection, where there is a vascular passage and the subcutaneous tissue is not very sufficient. Typically an appearance associated with vascular occlusion and circulatory impairment. The problem here seems to be the application technique. When a sharp white border appears during the filler injection, it can be thought that the filler was injected into the vein. Before the injection, the syringe piston should be pulled back and it should be checked whether the needle is in the vein /artery. During the HA filler injection, during superficial injections, the highlights of the filler color can be seen on the skin without sharp edges, but a black and red area surrounded by a white border like here is an indication that circulation has seriously decreased.
Photograph No. 2: In this photograph taken a few days after the first photograph, it is seen that the skin areas with the white border line in the first photograph are covered with inflamed pustules, the dark reddish area in the middle of the lesion has turned into a black necrosis area, and redness and inflammation areas have also appeared on the skin areas adjacent to this lesion.
Photograph No. 3: It is seen that the black necrotic gangrene area on the left nasal wing is larger and more clearly limited, two more black small necrotic areas have appeared on the left side of the nose on this lesion, and there are red and inflammatory areas on the skin up to the eye level. Unfortunately, tissue loss has become more apparent in this photograph and the change in the structure of the skin is more striking.
Photo Number 4: This photo, taken nearly two weeks later, shows tissue loss on the wing of the nose and irregular red scar tissue and granulation tissue in this area. The patient uses a U-shaped medical silicone material called nostril retaniner to prevent nostril stenosis. The patient's physician has prescribed hyperbaric oxygen therapy, oral antibiotics and the treatment recommendations I shared with you above.
Photo Number 5: Irregular scar areas on the wing of the nose and on the upper side of the patient and permanent tissue loss are seen. The wing of the nose has developed a notch, retraction and deformity. In similar cases, sometimes the infection can spread to the cartilage at the tip of the nose and cause serious deformity.
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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