摘要

Objectives: General objective The general objective will be to demonstrate that there are different protocols to avoid or treat vascular complications with different drugs, which must be administered in a timely manner so as not to generate iatrogenesis, in addition to emphasizing facial anatomical knowledge prior to the application of endodermal fillers. 1.- Specific Objective - Identify main adverse reactions to the application of endodermal injectables - Establish existing protocols for any adverse reaction that we present - Emphasize knowledge of facial anatomy Introduction: Complications are due to flow obstruction both by intra-arterial injection and by external compression of the vessel by the filling material. When intra-arterial injection generates a retrograde flow, it can obstruct arteries such as the central one in the retina. Injection in any area of the face can be dangerous, but the areas most at risk of inducing blindness are: the nose, glabella, forehead, and less frequently, the eyebrows, temples, and nasolabial fold. In the informed consent for these procedures, it is important to include the risk of skin necrosis and visual compromise. Materials / method: A 56-year-old female patient comes to us without an appointment at the clinic requesting medical attention, since HA (hyaluronic acid) had been placed on the lips in a place without doctors. Go to the 5th day of the application for which the following is displayed: schema data Scab on lips by scheme intense neuropathic pain Redness of the chin, submental fat and in the path of the nasolabial fold There was presence of purulent exudate on the lips and fibrin. Results: The protocol for a late ischemia is started, since it has 5 days of evolution, for which the most recommended is this protocol. Application of Enoxaparin inhibitory doses (anticoagulant) Long-acting intramuscular/IV steroids (Dexamethasone 8mg every day, for 7 days) Aspirin as a platelet aggregator (Only 500mg) since NSAIDs cause vasoconstriction and do not favor tissue oxygenation Hyaluronidase 1500 IU in the hyaluronic acid application site, 1500 IU of Hyaluronidase in places around the lesions (we repeat this application step of hailuronidase at least 3 times) Nifedipine 10mg long-acting Conclusion: Knowing how to recognize the clinical signs of arterial obstruction in a timely manner would make it possible to establish a rapid and effective treatment when this complication occurs. Initially, this is manifested by whitening of the skin during the introduction of the filler, with subsequent acute pain and erythema in the applied region. This complication is addressed with the use of hyaluronidase in case of having injected hyaluronic acid, topical vasodilators such as nitroglycerin cream, and steroids to prevent progression to necrosis.