for a fraction of cost required for a classic
facelift, injectable wrinkle
fillers can give you a more youthful appearance. in less than 30 minutes, most of the
fillers can fill in hollows, lines, and wrinkles with effects that will last from 4 months to more than a year. wrinkle
fillers can also be used as "volumizers," filling thin lips and plumping and lifting cheeks, chins, jawlines, and temples.
injectable
hyaluronic acid (ha) is a type of temporary dermal filler. hyaluronic acid is found naturally throughout the body, with the highest concentrations in the joints, eyes, and skin. in the skin hyaluronic acid attracts water, which allows the skin to become more hydrated. as we age, the fat, muscles, bone, and skin in our face begins to thin. this loss of volume leads to either a sunken or sagging appearance of the face, fine lines, wrinkles, folds, and thin lips. injectable ha is used to reduce the appearance of
fine lines and wrinkles,
facial folds, and to create structure, framework, and volume to the face and lips. the effects of injectable hyaluronic acid are seen immediately. hyaluronic acid is one of the most frequently used longevity filler that ranges from 6-24 months based on molecular size, cross-linking process, and area of injection.
• patient’s medical history and examination.
• areas to be treated should be kept clean.
• if there is a skin infection, then treatment needs to be postponed until the condition is treated.
• patients who take blood thinners (such as aspirin, ibuprofen, and certain herbal medications) should stop them two weeks prior to injection with the approval of their prescribing doctor.
who is not a candidate for hyaluronic acid?
injectable hyaluronic acid is not recommended for patients who have:
•
active
facial or oral herpes infection
• infection in the treatment area
• uncontrolled diabetes
• blood-clotting problems
• allergy to any components of injectable hyaluronic acid
• patients whom are pregnant or breast-feeding
is injectable hyaluronic acid painful?
topical numbing agents or anesthetic injections can be used to improve patient comfort during the injection process. also, lidocaine is commonly incorporated into most brands of i
ha fillers for further comfort measures. before and following treatment, ice may be given to ease discomfort and
swelling.
blinding and other horrors of iha
in general, hyaluronic acid supplements, topical products, and injections appear to be safe when people follow the instructions on how to use them and when they are administered by skilled professionals. however, hyaluronic acid may produce adverse side effects and allergic reactions in some people. a person should always do a test patch before they start using a new skin product
common side effects of iha include:
• bleeding
• lumps and bumps
• redness
uncommon side effects include.
• numbness
• allergic reactions
• infection
• blisters and cyst;
• inflammatory reactions
• migration of filler material to another site
• bluish discoloration
• vascular occlusion
• scarring
• blindness
mechanism of blindness after filler injections.
definition : any impairment or loss of vision (temporary or permanent) secondary to retinal or retinal branch occlusion occurring as a direct consequence of percutaneous injection for
aesthetic treatment.
blindness after
facial injection is extremely rare. terminal branches of the ophthalmic artery, namely the supraorbital and supratrochlear, supply the medial forehead, and anastomoses between these vessels and the terminal branches of the angular artery are well documented. injection of filler material into one of these vessels can lead to retrograde flow to beyond the point of the origin of the ophthalmic artery, and when pressure is released, the systolic pressure drives the product forward to enter the ophthalmic artery or central retinal artery, resulting in visual loss.
in order for blindness to occur, there must be retrograde and subsequent anterograde passage of material, injection pressure exceeding systolic pressure, and sufficient amount of material within the lumen of the vessel. findings indicate that the average entire volume of the supratrochlear artery from the glabella to the orbital apex is 0.085ml (range 0.04–0.12ml), and injection volume should not exceed this volume in critical injection points.
visual loss is often accompanied by sudden onset of severe pain (ocular,
facial, and/or headache), although central retinal and retinal branch artery occlusions might present without ocular pain.
other symptoms include ophthalmoplegia (paralysis or weakness of ocular muscles),
ptosis, enophthalmos (posterior displacement of the eye), and horizontal strabismus (abnormal alignment of the eyes). these symptoms accompany blindness due to disturbed flow to the superior and inferior branches, which supply the extraocular muscles.
minimizing the risk
the key preventative strategies are as follows
•
know the location and depth of
facial vessels and the common variations.
• inject slowly and with minimal pressure.
• inject in small increments.
• move the needle tip while injecting so as not to deliver a large deposit in one location.
• use a small-diameter needle.
• smaller syringes are preferred to larger ones as a large syringe can make it more challenging to control the volume and increases the probability of injecting a larger bolus.
• consider using a cannula (minimum size 25g), as it is less likely to pierce a blood vessel.
• use extreme caution when injecting a patient who has undergone trauma or a previous surgical procedure in the area.
• ensure that you are adequately trained, are using an appropriate product, are competent in treating the area you will be injecting, and are competent in the management of complications.
treatment of loss of vision (blindness)
• once the retinal artery has been occluded, there is a window of 60 to 90 minutes before blindness is irreversible.
• it is advisable to transfer the patient to the nearest hospital with an eye specialist via blue light ambulance as quickly as possible.
• the goal is to quickly reduce the intraocular pressure to allow for the emboli to dislodge downstream and improve retinal perfusion.
• stop treatment immediately. place patient in supine position.
• reduce intraocular pressure. administer timolol 0.5% 1 to 2 drops in the affected eye only. this will aim to reduce intraocular pressure by reducing aqueous humor production.
• the patient should be encouraged to “rebreathe” in a paper bag to increase co2 levels within the blood, which will cause retinal arteries to vasodilate and could help dislodge blockage.
• an alternative to rebreathing through a paper bag is the inhalation of carbogen (95% o2, 5% co2)
• administer hyaluronidase. if hyaluronic acid has been used, administer hyaluronidase to the treatment.
• injection of 500mg iv acetazolamia, which should increase retinal blood flow and reduce intraocular pressure.
• intravenous infusion of mannitol 20% (100mlover 30 minutes)
• steroid administration, intravenous dexamethasone.
• intravenous prostaglandin e14 to increase blood flow to the retina and decrease activation of thrombocytes and neutrophils.