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Specific Cases of Vascular Events

 

The author will demonstrate specific cases of the vascular events which occurred during the cannula procedures as below.

 

Bleeding

 

There is a recent case of bleeding in which hyaluronidase was intended to be injected with a 23 gauge (G) cannula in order to remove the nasolabial fold filler. At that time, the cannula penetrated the blood vessel, probably facial artery, and as a result, the bright red blood entered the syringe. The applicable patient was a female in her 20s who previously underwent an operation for a cleft palate.

 

A scar was partly left on her nasolabial fold. Thus, as fibrosis progressed in this region, the diameter of the blood vessels became large and their movements became small. In the author's judgment, this is why only the cannula could penetrate the blood vessel.

 

It was also decisive to have difficulty in distinguishing how it feels when the blood vessel was penetrated and when the skin tissue with the already progressed fibrosis was penetrated, respectively. Although the author made every effort to manipulate the cannula carefully and slowly, it was highly embarrassing to eventually penetrate the blood vessel.

 

This experience gave him an opportunity to have a careful thought about procedures. After long hours of reflection, the author has concluded that it is effective to use a rehearsal technique, like injecting the lidocaine in advance with a tumescent technique for a cannula injection into such dangerous regions.

 

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There is another recent case where bleeding continuously occurred when hyaluronidase was injected using a 27G cannula in order to dissolve the nose filler. The 27G cannula is highly likely to cause bruising as it can easily penetrate the blood vessel. In particular, the blood vessel may be more easily penetrated especially in the regions of which skin is thick and vascular movements are small.

 

If small-diameter cannulas (27G, 30G) are used, it is necessary to inject the filler material slowly and gently in small quantity (≤ 0.01cc) under the minimum pressure on the premise that even a cannula can penetrate the blood vessel. 

 

To be continued-