10 days after Juvederm there is a reticular pattern after erythema subsided and sloughing, dry skin. Is it infected? (photos)

Question

It's been 9.5 days since my initial Juvederm injection (1syringe). Erythema has subsided, but there's still a visible reticular pattern. Also, the skin in the area is slightly sloughing. Inside of my right nostril feels a bit dry. Initially (first 3 days) I could see a little blood in dried mucus. I saw an ENT 5 days ago and he didn't think it's Necrosis but likely severe swelling, possible infection, and I've been on Prednisone and Antibiotics since.I'm seeing my PS but wanted a second opinion.

Misbah Khan MD, FAAD, FACMS · Answer

I would recommend you get the filler dissolved ASAP. you can always add more once the nose is back to the way its supposed to be. but for now its causing vascular compromise. I have treated some cases where the filler was not advised to be reversed by the injector and by the time I dissolved it the necrosis had advanced quite a bit.

Jason Emer, MD · Answer

I recommend following up with your Doctor for a formal evaluation and treatment. If necessary, this can be removed with hyaluronidase. See an expert. Best, Dr. Emer

Nelson Lee Novick, MD · Answer

Although infection is certainly a possibility, a reticular pattern on the nose following the injection of a syringefull of filler should immediately ring the alarm bell of possible vascular compromise and appropriate action taken right away. At the earliest possible time following its development, it is medically wise to apply warm compresses to increase circulation;  apply nitroglycerin paste and take aspirin (if no contraindication to its use) in order to maintain and promote circulation; massage the injected regions vigorously to manually break up the hyaluronic acid; and very importantly to inject hyaluronidase (either Vitrase or Hylenex) as soon as possible. In a confined area such as the nose, had infection been the cause, I would have expected more swelling and discomfort than you seem to have complained of. While I have no serious objection to the use of antibiotics and prednisone, I would have instead concentrated upon instituting asap the measures mentioned above in order to minimize the possibility of the development of necrosis and subsequent scar formation. I would strongly urge immediate reevaluation and treatment with hyaluronidase even at this stage. I wish you all the best.

Hardik Soni, MD · Answer

Thank you for your question and I am sorry to hear about your complication. From your photo it does look like you may have an infection. Your best option at this time would be to have the filler dissolved with hyaluronidase. The nose is a very vascular area and very susceptible to necrosis and infection. I recommend having this evaluated by your treating physician. Best of Luck!

Jeanine B. Downie, MD · Answer

Hi there, this appears to be an emergency and should be treated with Hylauronidase immediately. The reticular pattern on your nose suggest possible vascular compromise. Please go back to the person that injected you and good luck. Dr. Downie.

Anthony J. Taglienti, MD · Answer

Thank you for your question. It's difficult to say exactly what is going on - but you're right to be on Prednisone and antibiotics. You likely may have had some slight superficial necrosis, or at least enough stress on the overlying nasal skin to cause sloughing - likely due to swelling. The other potential is, of course, an infection. You are doing everything correct, and when you see your Plastic Surgeon he or she may recommend dissolving the filler depending on how things evolve. There is a very good chance that none of the skin changes will be permanent, but close follow-up is recommended.

Michele S. Green, MD · Answer

I am so sorry for your complication to the injection.  It does appear from the photo that you could be having an infection.  I would definitely return to your treating physician to have this examined again.  You may need Vitrase to have the product removed and a different antibiotic to cover an infection.  The nose is a very vascular area and  susceptible  to necrosis and infection.  Please keep us posted.  Best, Dr. Green

10 days after Juvederm there is a reticular pattern after erythema subsided and sloughing, dry skin. Is it infected? (photos)

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