It has been hypothesized that the retrograde arterial injection of the fillers into the ophthalmic arterial system proximal to the central retinal artery might occur if the injection pressure exceeds the systolic arterial pressure. Monocular vision loss after calcium hydroxyapatite injection into the nasal tip and dorsum with multiple calcium hydroxyapatite emboli in the choroid vessels was also reported.

 

Although partial recovery of visual acuity after iatrogenic retinal artery occlusion following cosmetic calcium hydroxylapatite injection into the glabella region has been reported in another case, no reliable recovery treatments have been reported for such complications.

 

Other vascular complications of multiple small acute infarcts over the bilateral hemispheres in the middle cerebral artery territory after a hyaluronic acid nasal filler injection as well as bilateral vision loss with brain Infarction after hyaluronic acid injection in the glabellar area were also reported. Visual field defect after facial rejuvenation with combination therapy of botulinum toxin and polyacrylamide injection was described, too. It is obvious that any types of fillers, including hyaluronic acid, calcium hydroxylapatite, or polyacrylamide, can have vascular occlusive complications.

 

Rare complications like filler migration to the forehead due to multiple filler injections (hyaluronic acid and poly-L-lactic acid) into cheeks, and facial cellulitis with Ludwig's angina due to deep neck space infection following a local injection of calcium hydroxylapatite filler for facial lifting have also been reported in Taiwan (Table 1). 

 

Table 1. Summary of reported severe complications after fillers injection in Taiwan.

 

HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)

 

Prevention of Fibrosis

Zafirlukast, a leukotriene antagonist, has emerged as an effective prophylactic agent in the management of reactive airway diseases, and recently has been used as an off label prophylactic agent against the capsular contracture after breast augmentation. The nodule formation or intradermal fibrosis after filler injection, especially poly-L-lactic acid or calcium hydroxylapatite, can sometimes happen. Recently, some dermatologists in Taiwan try to use Zafirlukast to treat or prevent this complication. Although there is still no experimental research or clinical study in the medical literature about the effect of Zafirlukast on the nodule or fibrosis formation after fillers injection, the protective action of Zafirlukast may be attributed to its anti-TGF action, which plays an important role in fibrosis formation. 

 

-To be continued