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In particular, facial, angular, and infraorbital arteries are interconnected in nose, nasolabial fold, and front cheekbone areas.

 

Therefore, it is dangerous to inject a large volume of filler into these regions at one time because the blood vessels in multiple regions may be pushed all at once. The filler injection requires greater caution than usual and under-correction.

 

There is another case of injection necrosis in a female patient in her 20s who received a nose filler with a 24G cannula at this hospital one year ago. This event occurred when six months had passed since the second cannula procedure was initiated.

 

At that time, the author was not completely proficient in performing a nose filler procedure using cannulas because he had mainly used needles. Skilled manipulation of cannulas seem to need more time and effort and greater anatomical knowledge than needles.

 

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Blanching was suddenly witnessed when the filler was injected to improve even the glabellar frown lines during the nose filler. 

 

The affected region was palpated to found the clumping of the filler. Initially, there was an attempt to massage the lump from the filler, but it was ineffective.

 

Subsequently, hyaluronidase was injected into the region to dissolve the filler, but at that instant, the forehead and the nose ridge became so suddenly mottled that a regular treatment was initiated while dissolving even the fillers in these regions.

 

However, the skin was peeled off with too much massage after dissolving the fillers with hyaluronidase. Therefore, it took long time to treat these regions with leaving no scar.   

 

- To be continued