What will happen to vein occlusion due to Radiesse nose injection?

Injection of Radiesse into the nose or forehead is a well known "danger zone" for reasons that you have already discovered.  This problem will either lead to gradual resolution, or less commonly to skin necrosis.  I will generally pre-inject the treatment sites with Lidocaine 1% with 1:100,00 epinephrine in order to minimize chances of this complication.

Although I have never experienced this dreaded complication, the area around the nose is known danger area and fillers placed here may result in vascular compromise.  It sounds as if you may have had intravascular injection, or more commonly, vascular compression from your Radiesse treatment.  If this was arterial compromise you would not likely see the symptoms you describe so you are probably dealing with a venous occlusion and will have resolution of your symptoms without any long term sequelae.

Vein occlusion results in bruising but no loss of tissue or surrounding skin. If it had been an arterial occlusion then that may have been catastrophic with skin necrosis and scarring. Because of the great vascular connections of your skin there is no need to worry about the vein occlusion.

 

David Ellis MD FRSCS Toronto Facial Plastic Surgeon at Art of Facial Surgery

I have not personally encountered this complication from Radiesse injections, but from what you describe, you most likely had a venous occlusion. This is much less prone to cause skin necrosis and scarring than would the more dreaded arterial obstruction, and given the course of events you've had so far, the bruising should be the worst of it. Follow your physician's instuctions and you should get gradual resolution of the problem.

I have used Radiesse in the nasal area for relatively minor imperfections, and have many satisfied patients. For me, the key is to use only small amounts and keep the injections just on the periosteum of the nasal bones so as to minimize the chances of an intravascular injection.

Time will tell. One additional medication that it is often used for this type of problem is nitro paste. This leads to vein dilation and can sometimes improve these symptoms. Otherwise, keep the area moist and watch for signs of infection (redness, drainage, swelling, fever) and keep in touch with your doctor. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery

The natural history of thrombophlebitis is that it will improve - but, something like Radiesse injected into a vein inadvertently will likely not resorb or absorb and may (I reiterate MAY) be a chronic problem. This is a danger area and hopefuly it will not get infected (unlikely) and it will improve. Best bet, if it is a vein, is to have it excised with micropuncture incision and a plastic surgery or HEENT (head and neck specialist) can deal with it for you.

This will most likely resolve on its own, although it may take a while.  You should be seen by a board-certified plastic surgeon if you have not already done so, just to have someone like that to follow your course.  If it is truly a venous occlusion, which is what it sounds like, then as the swelling around the Radiesse diminishes, and then the Radiesse itself degrades and is resorbed, this shoudl go away without any other treatment.  Skin loss is rare, though it can occur.  An arterial occlusion would be exponentially worse than this so, from that standpoint, it's fortunate.  I cannot say more via this forum but you should be seen by someone in person and followed closely as this takes its presumed favorable course.

Sorry, but hopefully it will be okay,

Dr. E

There are many veins in this area, so some of what you are asking depends on which vein was injected and blocked. That first must be discovered by an appropriate specialist. Sometimes, like if it's an arterial vein, the filler has to be immediately removed. This is difficult with Radiesse because there is no agent, like hyaluronidase, that can dissolve it. That means that it has to be surgically cut out. Although off-label usage, in rare instances, I have seen Viagra help too. If the blockage is small enough, and enough blood flow can force it, sometimes it can remove the filler. Again, it will depend on how much is blocked though and that is variable in this case. Viagra increases blood flow wherever it's not going (which is why it's used for sexual problems) but in cases like this (and in some other conditions) taking Viagra can force blood to flow there. If not, the blood flow gives up going to that area, and yes, if it's an arterial vein, you can get skin necrosis and that area of skin will die. This will mean a great deal of correct surgery and possible skin grafting in the future. You need to get the blood flow corrected if it is an arterial vein, or wait to see what happens as it resolves if it's not. I would suggest you see a specialist, like an ENT to determine what the next best steps are in this case. It's not an easy answer since its Radiesse and also not easy since we aren't sure which vein is blocked.

 

There are a number of veins that drain around the eyes and nose. It is not unheard of to occlude one of these. The worst problem occurs when one of the veins is injected and the occlusion occurs deep, especially around the optic nerve. This can cause blindness. This is why I use a blunt needle in this area, to try and avoid injecting a vein. If all you have is some bruising (what you have described), then it will resolve with time. Warm (not hot) compresses and the Arnica are the only treatment other than time and a little camouflage make up.