Arterial Embolization and Skin Necrosis of the Nasal Ala following Injection of Dermal Fillers

作者：Keita Inoue, Katsujiro Sato, Daisuke Matsumoto, Koichi Gonda, Kotaro Yoshimura · 发表于：Plastic & Reconstructive Surgery · 年份：2008 · DOI：10.1097/01.prs.0000300188.82515.7f · 被引用次数：87 · 研究领域：Facial Rejuvenation and Surgery Techniques、Dermatologic Treatments and Research、Facial Nerve Paralysis Treatment and Research

Sir: The most common adverse effects of injection of biodegradable dermal fillers are bruising and erythema in the acute phase and allergic changes, abscess formation, and granulomatous change in the chronic phase.1–3 The most serious side effect is localized tissue necrosis, which is induced by mechanical interruption of local vascularity, though it occurs very rarely (nine in 10,000 patients who underwent collagen implantation).2 The only reported case of arterial embolization induced by hyaluronic acid injection involved the glabellar region.4 A 50-year-old Japanese woman with no previous history of cosmetic surgery underwent injection of hyaluronic acid gel (Restylane; Q-Med, Uppsala, Sweden) to shape the nasal tip contour and of human tissue–derived, reconstituted collagen matrix (Sheba; Hans Biomed, Daejeon, South Korea) for wrinkle correction of the upper white lip and nasolabial fold and augmentation of the upper vermilion. Immediately after the injection, the patient had a striking pain on the left side of her face. A few hours later she noticed reddish discoloration from the left side of the nose and upper lip to the glabellar region, which corresponded to the area nourished by the angular branch of the facial artery. By the third day of onset, blisters had appeared at the left nasal ala. When the patient consulted our hospital on the sixth day, a gangrenous skin necrosis measuring 1 × 1.5 cm was present on the left nasal ala (Fig. 1). Three-dimensional computed tom...