Dr. Jair Mauricio CERON BOHORQUEZ
Cosmetic Surgeon
Skin type 5 crisis: unmasking the hidden vascular challenge
Objectives: - Understand the stages of vascular adverse events related to filler in darker skin types
- Remark how injection anatomy and complications can be made visible through facial ultrasound
- Learn the principles of ultrasound guided hyaluronidase injection to treat vascular adverse events
- Underline the importance of a multimodal and early wound- and scar treatment for necrosis at late stage
Introduction: A 41y old female patient Fitzpatrick photo type 5 presented 3 days after chin augmentation with hyaluronic acid-based filler with a vascular adverse event at skin ischemia stage 3-4. One day after initial treatment, quarantine was obligatory due to COVID 19 infection with severe symptoms.
Materials / method: A watch and wait approach, 1g of aspirin and tissue warming was decided due to impossibility to asses. Clinical assessment took place 5 days after treatment and negative COVID test, a stage 5 skin ischemia was diagnosed with local vasospasm of the superficial chin fibro-fatty layer via ultrasound. Dissolving via us-guided low-dose hyaluronidase injection (Schelke Protocol) released the vasospasm as well as the pain and pressure immediately, the blood flow was increased in the us-duplex imaging. Wound care and early-induced multimodal scar therapy was performed.
Results: After all, the patient shows minimal scarring and hyperpigmentation, the outcome of the chin augmentation was not influenced, no re-treatment was needed.
Conclusion: Early diagnosis of vascular adverse events is particularly challenging in individuals with darker skin types due to the subtler skin changes observed during the initial stages of ischemia.
Even after presentation at late stage of skin ischemia, ultrasound guided low dose hyaluronidase infiltration helped to restore the blood flow through the superficial perforators, pain and pressure release and avoid severe scarring.
The management of vascular adverse events using ultrasound allows for precise diagnosis and the precise administration of low-dose hyaluronidase injections.
