Hyperbaric Oxygen for Ischemia due to Injection of Cosmetic Fillers (original) (raw)

Plastic and Reconstructive Surgery - Global Open

Natural and synthetic fillers have revolutionized aesthetic facial rejuvenation and soft-tissue augmentation to treat volume loss, dermatological diseases, age-related changes such as tear troughs, wrinkles, depressed scars, and also for lip, cheek, and chin augmentation. 1 We present the case of a patient who self-injected with a hyaluronic acid filler and required intervention for complications including hyperbaric oxygen therapy (HBO2). We will discuss the utility of HBO2 and the ease of obtaining product, and the need for regulations and self-governance. CASE A 37-year-old woman self-injected Juvederm Voluma XC (a hyaluronic acid gel, Allergan, Irvine, CA) on both sides of her face around the proximal temple. Immediately after injection, she experienced hearing loss in her left ear, blanching over the left side of her face, and severe pain. Prompt treatment with hyaluronidase, topical nitro paste, and warm compresses ensued. With no improvement 9 hours after the injection, she presented to an outside emergency department with signs of ischemic changes to her left face and postauricular area and also hearing loss but no other vestibular symptoms. A computed tomography angiography of the head showed occlusion of a branch of the left superficial temporal artery. They treated her with enoxaparin, aspirin, dexamethasone 10 mg IV, piperacillin/tazobactam, and intradermal 1% lidocaine (0.1 ml per site). Our facility accepted her in transfer for hyperbaric oxygen treatments for vascular insufficiency. Beginning 15 hours after the initial insult, she received 6 total treatments, done twice daily, the initial 2 at 3.0 atmospheres absolute for 90 minutes followed by 4 treatments at 2.4 ATA × 90 minutes, all with air