Severe embolism after injection rhinoplasty with hyaluronic acid

Introduction:

Non-operative rhinoplasty by the use of fillers like hyaluronic acid is routinely performed. It is advertised to circumvent surgery achieving a visible change in the shape of the nose. But in some cases severe complications like embolism cause permanent damages. We want to show a case of our clinic and give an overview of existing literature as well as proposals for the therapeutic management.

Case:

A few hours after nose and cheek augmentation with hyaluronic acid in an outpatient surgery a 29 year-old female presented to our clinic. She suffered from headache, vomiting and impaired vision. Skin on rhinion, nasal apex, forehead and glabella was livid indicating afflicted perfusion.

We induced cranial MRI and angiography studies and consults by opthalmology, dermatology, and neurology. So the diagnosis of an opthalmic artery embolism was established. It was suspected to be the result of inadvertent arterial injection of hyaluronic acid. The skin ischemia was accompanied by right oculomotor nerve palsy, choroid ischemia, and a reduction in visual acuity to 0.8 cc.

She received ampicillin/sulbactam, high-dose methylprednisolone and low molecular weight heparin systemically in addition to conjuncitival dexamethasone and subcutaneous hyaluronidase in the affected regions. The patient was left with a scar on the nasal apex, the vision impairment and a partial oculomotor nerve palsy. Other complaints were mostly alleviated by this treatment.

Conclusion:

Intravasal injection of fillers can cause severe ischemic injuries, which call for prompt and multidisciplinary treatment.

Publication History

Publication Date:
23 April 2019 (online)