Objectives: To offer effective laser alternatives of treatment for vascular occlusion after cosmetic fillers
Introduction: Vascular occlusion after cosmetic fillers has been increasing in incidence lately. However, guidelines fail to offer alternatives to patients in extreme pain, allergy to and/or with other contraindications for hyaluronidase treatment. We hereby present a case report of vascular occlusion after use of hyaluronic acid (Volbella, Allergan - IR) in right supralabial area.
Materials / method: Patient's complaint was “purse string” wrinkles, and hyaluronic acid was performed intradermally. Ecchimosis emerged, but no pain was reported then. Next day, the patient returned with "pain and red lesions" on upper lip. Diagnose was vascular occlusion, with mottled ecchymosis, blanching and a bright red patch on top of the right upper lip. 400 units of hyaluronidase were injected with cannula in the affected area, until most of the signs subsided. The patient complained thoroughly of pain and the procedure had to be suppressed. Although under Aspirin and Tadalaphil, pain persisted.
Results: After rejecting hyaluronidase (day 4), we treated the area with intraoral erbium laser followed by low dose ND:YAG (both Solon platform), while medication were kept. The patient underwent 10 ml ozone therapy (day 5), then rejected any new injectable. Pain remitted the following day, with great skin improvement, although a red patch persisted. The case had its complete resolution without any scarring 20 to 30 days after procedure.
Conclusion: Patients with a great deal of pain will reject painful interventions such as hyaluronidase, even followed by anesthetics. Guidelines for fillers complications need to consider alternative reperfusion techniques to reduce the skin suffering for these patients who cannot deal well with pain or face allergy to hyaluronidase. We present a case of successfully treated vascular occlusion with ozone and lasers.
Declaraciones
¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No
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Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.