I got a Juvederm injection last week. She gave me vascular occlusion and beginning stages of necrosis. How to stop it? (Photo)

Question

Juverderm plus injected directly into my artery. On week 2 now looks more like second degree burn after melting some filler out. What/ how can I fix this and will I need corrective measures.

Stephen Prendiville, MD · Answer

This is a rare but serious complication with fillers.  It looks as if the inferior labial artery was affected based on the photos.  This should be a fairly deep artery that should be out of the plane of injection  when treating the lip.  My first point is tat you need to be under the guidance of an experienced facial plastic surgeon, plastic surgeon, or dermatologist.  Although such complications could happen to any Injector, it would be far more preferable to see a Core Trained Physician with knowledge of facial anatomy and blood supply for future fillers.  This complication may lead to objectionable scarring; only time will tell.

John J. Martin, Jr., MD · Answer

This is an unfortunate complication of filler.  It sounds as though they used hyaluronidase to "melt" it out.  That is the most important thing to do when this occurs.  With a vascular occlusion the skin usually turns white and it can be painful.  This is when the treatment to dissolve needs to start. It is recommended that high doses of enzyme are injected every hour until it appears as though blood flow has returned.  All of the other modalities such as nitropaste, aspirin etc. are not nearly as important as high dose hyaluronidase.  At 2 weeks there is no benefit to adding more enzyme.  You should keep it moist with some topical antibiotic cream.  Warm compresses will also help.  As it heals, you may benefit from some laser treatments to improve the texture of the skin if necessary.

Thomas Fiala, MD, FACS, FRCSC · Answer

I am sorry to hear of your situation.  I'd recommend:Lots and lots of hyaluronidase.  Repeat.Nitropaste, aspirin, medrol dosepack.Topical wound care.Even consider hyperbaric oxygen treatments.

Jonathan Kulbersh, MD · Answer

I recommend following up with your injector or a Doctor as soon as possible. The filler can be reversed with hyaluronidase and should be treated with topical vasodilators (nitropaste) as prevention. I hope this helps.

Monika Soni, MD · Answer

Thank you for your question. It is difficult to give you advice without examining you in person. However, if necessary you can have the filler dissolved with hyaluronidase. I recommend having a follow up with your injector for an evaluation. Best of Luck!

Harlow Hollis, MD · Answer

Certainly looks like a vascular occlusion. Kind of late for anything except wound care. Injecting hyaluronidase is THE EMERGENCY TREATMENT at the time of the occlusion and even a day or so thereafter. Injections now, more than a week later,  might help but I don't think so. Worth a try? Possibly but Injections are a type of trauma in their own right and you don't want to do any more injury to these already compromized tissues!Wound care is important now. You should be in the care of someone who is expert in trauma and/or burn wound care. I see your lip itself looks relatively healthy which suggests your recovery might be not too bad. Good luck.By the way: Your injector's response should have been to inject lots of hyaluronidase and repeatedly for a few hours or more as soon as the problem was created.....even the next day if needed.

Marek Kacki, MD · Answer

You are 2 weeks after the event and in process of healing. There should be no long term consequences. Remember that the tissue at this moment is very fragile so be very gentle. Your doctor used hyaluronidase very appropriately. All other measures are of less importance. For the future, there are measures to minimize the risk of vascular compromise and your doctor is most certainly aware of those. They include: use of a cannula instead of the needle if your doctor is able to use it, very slow injections and avoidance of large amount of filler injection in a single point. There are some other very important factors to minimize the risks of this most dreadful possible side effect. This should be an unusual complication but the true incidence is unknown since most of the time the cases are not reported. Since you have had a misfortune to suffer this side effect, try to read about it as much as you can.The more you know the safer you will be! Good luck!

T.G. Khan, DO, FACS · Answer

I certainly agree that he and have the hyaluronidase repeated daily. The hope is that the area it will re-perfuse with blood and there will be no permanent damage. Call and see your doctor again today.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Your specialist who injected this would know exactly what to do- Hylase, ab cover, aspirin, nifedipine, wound care, swabs, anti viral care, hyperbaric oxygen, GTN etc...etc..etc. You do need to someone ASAP. If someone can or should be allowed to perform a filler, they should be well versed in picking up the early signs of occlusion and should tissue be compromised, they should have the skills and knowledge to repair, rejenate and correct.

I got a Juvederm injection last week. She gave me vascular occlusion and beginning stages of necrosis. How to stop it? (Photo)

Answers (9)

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