Management of impending skin necrosis following soft tissue filler procedure
Ramamurthy Subramaniam
Aesthetic Academy Asia, Malaysia
: J Aging Geriatr Med
Abstract
Facial fillers are becoming increasingly popular aesthetic procedures to temporarily reduce facial lines and folds, augment facial features or volumize facial compartments. However, even in the hands of very experienced injectors, there is always the possibility of dangerous complications like vascular injury, vascular occlusion by surrounding filler substance and intravascular injection of filler substance, which may lead to necrosis, blindness or even death. A prudent practitioner should be aware of the steps to minimize the risk of vascular complications, be able to identify the features of such complications promptly and to take the necessary steps to address those complications. It is useful if practitioners can group the steps to minimize the risk as patient factors, product factors and procedure factors. It is also prudent for the injecting physician to understand not only the facial anatomy but also the anatomy of an aging face as well. A detailed cosmetic or surgical history or history of trauma to the injecting site, as well as knowledge of the different concentrations, viscosity, G-prime and indication of the chosen filler is equally important. Though there are so-called claimed danger zones which are more dangerous than other areas, it is safer to adapt a “There is no safe zone” approach. Early detection and interference in the progression of a comprised vessel cannot be underestimated. Several journals claim that early intervention may reverse the complication and prevent necrosis or even blindness. Treatment modality differs for necrosis resulting from obstruction by surrounding fillers and necrosis due to intravascular cannulation. Thus the treatment options and drugs should base on the causative factor. Having an emergency “Filler Rescue Kit” is as important as having the contact details of a plastic surgeon, ophthalmologist and neurologist for referral.
Biography
Ramamurthy Subramaniam has been practicing aesthetic medicine since year 2000. He has been conducting training program for doctors since 2010 when he was appointed as a Lecturer and later as the Head of Department of a Medical University in Malaysia. He currently chairs Aesthetic Academy Asia. He was awarded the Letter of Credentialing & Privileging (Aesthetic Medicine) on an honorary basis by the Malaysian Ministry of Health in 2013. The esteemed Socrates Almanac Society, Oxford also awarded him for his contributions for the intellectual progress of modern society. He is a Trainer and key opinion Leader for Algeness Dermal Filler, Decoria Dermal Filler, Xeomin Neurotoxin and N-Finders PDO thread lift. He has published papers related to pain management in aesthetic medicine, botulinium toxin, dermal fillers and lasers.
E-mail: dr@daos.us
