Objectives: Blindness from dermal fillers arises from vascular occlusion, typically via retrograde embolization into the ophthalmic artery, leading to retinal artery occlusion (RAO). High-risk zones—nose (40.6%), forehead (27.7%), and glabella (19.0%)—correlate with arterial pathways like the supratrochlear and supraorbital arteries. Preventive measures include anatomical training, cannula use, and slow-injection protocols.

Introduction: A systematic literature review spanning 2018–2024 was conducted, analyzing case reports and studies on filler-related blindness, including seminal works by Lazzeri et al. (2012) and Kim EG et al. (2014). Data from a 2024 Aesthetic Surgery Journal review, identifying hyaluronic acid in 76% of cases, informed the focus on high-risk zones (nose, forehead, glabella) and treatment efficacy. Techniques such as hyaluronidase administration and intra-arterial interventions were assessed using clinical outcomes from peer-reviewed sources and ISAC Group World Guidance.

Materials / method: Management hinges on rapid recognition (within a 10-15-minute reperfusion window) and hyaluronidase administration, with the supraorbital method— championed by Dr. Treacy since 2013—preferred over retrobulbar injections (effective in only 5.3% of cases). A 2022 case by Nguyen et al. demonstrated vision recovery from no light perception to 20/50 using intra-arterial hyaluronidase and thrombolysis, highlighting advanced rescue potential.

Results: Blindness from dermal fillers arises from vascular occlusion, typically via retrograde embolization into the ophthalmic artery, leading to retinal artery occlusion (RAO). High-risk zones—nose (40.6%), forehead (27.7%), and glabella (19.0%)—correlate with arterial pathways like the supratrochlear and supraorbital arteries. Preventive measures include anatomical training, cannula use, and slow-injection protocols. Treatment efficacy hinges on rapid intervention within a 10-15-minute reperfusion window. The supraorbital hyaluronidase method, now favoured after being championed by early advocates,

Conclusion: Dermal filler-induced blindness, though an infrequent complication, remains a critical concern in aesthetic medicine due to its severe impact on patient quality of life. This analysis highlights that vascular occlusion, particularly in high-risk zones like the nose, forehead, and glabella, can be mitigated through rigorous anatomical training, refined injection techniques, and prompt emergency protocols. The shift toward cell-free interventions, such as hyaluronidase administration via the supraorbital approach and emerging intra-arterial therapies, offers hope for improved outcomes

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: This presentation aims to reveal the anatomy of the subdermal vascular plexus, including its different patterns, location, diameter, and territories in each facial region, as well as the correlation between the dermal vascular plexus and the particle size of biostimulators. Therefore, understanding dermal vascular anatomy is extremely significant for injectors to grasp the mechanism of intravascular injury and the various techniques to resolve vascular complications depending on the type of biostimulator used.

Introduction: Intrinsic and extrinsic skin aging can lead to dermis deterioration through increased collagen breakdown and decreased collagen synthesis. Several collagen biostimulators, including calcium hydroxylapatite (CaHA), PLLA, and PDLLA, are used to improve skin aging. Depending on the type of biostimulator, injection technique, and dilution, they can be injected into various layers. However, vascular occlusion due to accidental intravascular injection, compression, or vessel wall injury following subdermal injection has been consistently reported.

Materials / method: Ten complete, soft-preserved cadavers were included in this study. The principal trunks and subcutaneous perforators of the arteries supplying the face, specifically the facial artery, transverse facial artery, and superficial temporal artery, were meticulously dissected using a surgical microscope. The pattern, location, depth, diameter, and vascular territory of the subdermal vascular plexus were thoroughly investigated. Subsequently, the anatomical data were correlated with the characteristics of various biostimulator products.

Results: The subdermal plexus varies in pattern, diameter, and territory across facial regions. The lateral cheek, forehead, and mandible feature a wide territory and large diameter plexus, while the medial cheek has a small territory. Correlationally, large biostimulator particles tend to occlude subcutaneous perforators, and small particles may obstruct the subdermal plexus. Consequently, varying degrees of obstruction will impact different tissue structures

Conclusion: In summary, comprehending the correlation between the dimensions of the vascular plexus and the characteristics of the material microsphere serves as a crucial guideline for addressing biostimulator-related vascular complications. This information is significant for predicting the potential severity of skin necrosis following intravascular injection. Furthermore, such data will enable practitioners to perform injections with greater confidence and a reduced risk of vascular compromise.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: This lecture aims to provide participants with an advanced understanding of diagnosing and managing vascular complications that may arise from dermal filler injections. It will cover the significance of thorough patient assessments, effective injection techniques, the use of hyaluronidase in reversing complications, and the necessity of having emergency protocols in place. By the end of the lecture, participants will have enhanced knowledge and skills to minimize patient risks, effectively manage vascular complications in a timely manner, and improve overall patient outcomes.