Reticulated livedoid skin patterns after soft-tissue filler–related vascular adverse events

Abstract

BackgroundFor the treatment of vascular adverse events caused by filler injections, duplex ultrasound imaging may be used. The findings of duplex ultrasound examination and the clinical features of reticulated livedoid skin patterns were compared to the hemifaces anatomy. Objectiveto link the reticulated livedoid skin patterns, to the corresponding duplex ultrasound findings and the facial perforasomes. Methodsduplex ultrasound imaging was used for diagnosis and treatment of vascular adverse events. The clinical features and duplex ultrasound findings of 125 patients were investigated. Six cadaver hemifaces were examined to compare the typical livedo skin patterns to the vasculature of the face. ResultsClinically, the affected skin showed a similar reticulated pattern in each facial area corresponding with arterial anatomy and their perforators in the cadaver hemifaces. With duplex ultrasound, a disturbed micro vascularization in the superficial fatty layer was visualized. After hyaluronidase injection, clinical improvement of the skin pattern was seen. Normalization of blood flow was noted accompanied by restoration of flow in the corresponding perforator artery. The skin patterns could be linked to the perforators of the superficial fat compartments. Conclusionthe livedo skin patterns seen in vascular adverse events may reflect the involvement of the perforators