Laser Doppler Imaging for Treating Vascular Complications from Procedures Involving Dermal Fillers: Case Series and Literature Review

An-Li Lee,Kwang-Yi Tung,Wen-Chen Huang,Ying-Chun Liu,Yu-Fan Chen,Wen-Teng Yao,Ming-Feng Tsai,Chia-Meng Yu,Chih-Peng Tu,Chieh-Ming Yu

doi:10.3390/diagnostics11091640

Abstract

Vascular occlusion is a rare but severe complication of dermal filler injections. Early treatment of this complication produces better outcomes. Current diagnostic methods for vascular occlusion in the skin are subjective and imprecise; these include capillary refill time, skin color, and reports of pain. This study aimed to assess the use of laser Doppler imaging (LDI) in the evaluation and treatment of vascular complications caused by dermal filler injections. This retrospective study used laser Doppler imaging (LDI) in 13 patients who developed vascular occlusion after facial dermal filler injections, with subsequent follow-up. The precise areas of perfusion observed on LDI were compared with the findings of clinical and photographic evaluation. The results showed that LDI accurately identified areas of vascular occlusion and improved treatment precision among these thirteen patients. The procedure was more precise than visual inspection or photographic evidence. Satisfactory outcomes were achieved for all patients, and no procedure-related complications were reported. Collectively, LDI provides fast, noninvasive, and accurate delineation of areas of vascular occlusion caused by complications of dermal filler injections and avoids several subjective shortcomings of visual and photographic evaluations. Thus, LDI effectively tracks treatment outcomes. However, large-scale studies are required to confirm the present findings.

Highlights

Dermal filler injections are used widely in cosmetic surgery to fill deep lines and wrinkles and augment tissue [1], and their use has increased dramatically in recent years
Patients who developed cyanotic skin changes after facial dermal filler injections were included in this study, whereas those without significant evidence of inadvertent intravascular injection after facial dermal filler injection or of skin perfusion defects on the first laser Doppler imaging (LDI) measurement were excluded
LDI allowed the accurate identification of areas with vascular occlusion following inadvertent intravascular injection of the dermal filler material with greater precision than visual examination or photographic evidence

Summary

Introduction

Dermal filler injections are used widely in cosmetic surgery to fill deep lines and wrinkles and augment tissue [1], and their use has increased dramatically in recent years. In. 2017, the American Academy of Plastic Surgeons reported 2.7 million procedures involving dermal filler injections. 2017, the American Academy of Plastic Surgeons reported 2.7 million procedures involving dermal filler injections This represented a 3% increase over the previous year and an increase of over 250% from 2000 [2]. As many as 71% of these procedures involved the use of hyaluronic acid (HA)-based fillers in 2013 [3]. Cases of vascular complications arising from procedures involving dermal filler are extremely rare. Other authors have suggested a vascular complication rate of 0.09% for procedures involving collagen implants [5]. The rate of inadvertent intravascular injection has been estimated as 3 per 1000 with calcium hydroxylapatite and 3–9 per 10,000 with HA-based products [6]

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