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Cases of Emergent Vascular Events

 

There are cases where the filler may be injected into the blood vessel even if the cannula is used, as below:

 

1. In the case of using a small-diameter cannula.

 

2. In the case of injecting the filler in a hurry.

 

The rushed state of mind due to the closing time drawing near or the large number of patients waiting for procedure is highly likely to contribute to rough performance and a large bolus of filler injection. This results in the increased risk of events. It is necessary to gradually and gently inject the filler material in small quantity.

 

3. In the case of injecting too much quantity of filler material at one time. The bolus of filler to be injected into one region may be large if there is a demand from the patient or the injector has a great concern for creating a more complete shape. In particular, the layers in which the injector mainly injects the filler with a mind to create a more complete shape are the subcutaneous layers where a lot of blood vessels are distributed.

 

As for the nasolabial fold filler, the drooping regions next to the nasal wings are applicable to the subcutaneous layers. When it comes to the forehead and nose fillers, the subcutaneous layers are above the eyebrows and at the end of the nose, respectively. 

 

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4. In the case the region in which the filler is injected is under much pressure and deep. This is where a surgery was performed previously or a fibrosis has already progressed. In other words, it is related to when a filler is injected into the region where the rhinoplasty was performed previously; or a nasolabial fold filler is injected into the region where the paranasal augmentation was performed previously.

 

In this case, it is easy to penetrate the blood vessels as there is no vascular movement and the blood vessels get swollen. Additionally, when the cannula is used to inject the filler into the facial artery in the midfacial region with a complex anatomical structure and the infraorbital artery in the buccal region, the injectors should be well acquainted with anatomical structures and perceive filler injection by the sense of touch and sight during a procedure.

 

5. Vascular events may occur in the case where the injectors does not well know the anatomical structure of the region in the filler is injected. In particular, the injectors should know exactly not only the movement pathway and depth of blood vessels but the structure of the area where the cannula tip is located during a filler procedure.

 

Although it is impossible to precisely predict the exact pathway because blood vessels have many anatomical variations, the risk of vascular events becomes low only when the location is approximatively identified.

 

6. In the case of being unskilled at manipulating the cannula. In this case, the injectors should be aware that even the cannula injection can penetrate blood vessels like the needle injection and carefully and gradually perform a filler procedure in small quantity. The cannula procedure requires more time to become proficient than the needle procedure. 

 

- To be continued