ABSTRACT
Hyaluronic acid filler injection is commonly used for aesthetic purposes. However, many clinicians neglect the possibility of developing vascular occlusion and its devastating sequelae. Besides visual loss after iatrogenic ophthalmic artery occlusion, ophthalmoplegia without blindness is rare but may occur. Here, we report a 23-year-old woman with ptosis, lateral deviation of the right eye, and skin necrosis after hyaluronic acid filler injection. After hyaluronidase injection and steroid pulse therapy, ptosis and eye movement were completely restored. Skin necrosis was treated with a human epithelial growth factor ointment, followed by Nd:YAG laser. Complete healing with minimal scar was achieved.
Subject(s)
Cosmetic Techniques/adverse effects , Dermal Fillers/adverse effects , Hyaluronic Acid/adverse effects , Ophthalmoplegia/etiology , Skin/pathology , Dermal Fillers/administration & dosage , Diffusion Magnetic Resonance Imaging , Face , Female , Humans , Hyaluronic Acid/administration & dosage , Lasers, Solid-State , Low-Level Light Therapy , Necrosis/etiology , Necrosis/therapy , Oculomotor Muscles/diagnostic imaging , Oculomotor Muscles/drug effects , Ophthalmoplegia/therapy , Treatment Outcome , Young AdultABSTRACT
A new injectable tissue-engineered soft tissue consisting of a mixture of hyaluronic acid (HA) filler and cultured human fibroblasts have been developed by the authors. To establish this method as a standard treatment, a further study was required to determine whether the injected fibroblasts could stay at the injected place or move to other sites. In addition, effective strategies were needed to increase viability of the injected fibroblasts. The purpose of this study was to track the injected fibroblasts and to determine the effect of adding prostaglandin E1 (PGE1) or vitamin C on the viability of fibroblasts.Human fibroblasts labeled with fluorescence dye were suspended in HA filler and injected into 4 sites on the back of nude mice. The injected bioimplants consisted of one of the 4 followings: HA filler without cells (HA group), fibroblasts suspended in HA filler (HAâ+âFB group), PGE1-supplemented fibroblasts in HA filler (HAâ+âFBâ+âPGE1 group), and vitamin C-supplemented fibroblasts in HA filler (HAâ+âFBâ+âVC group). At 4 weeks after injection, locations and intensities of the fluorescence signals were evaluated using a live imaging system.The fluorescence signals of the fibroblast-containing groups were visible only at the injected sites without dispersing to other sites. The HAâ+FBâ+âPGE1 group showed a significantly higher fluorescence signal than the HAâ+âFB and the HAâ+âFBâ+VC groups (Pâ<â0.05, each). There was no statistical difference between the HAâ+âFB and HAâ+âFBâ+VC groups (Pâ=â0.69).The results of the current study collectively suggest that injected fibroblasts suspended in HA filler stay at the injected place without moving to other sites. In addition, PGE1 treatment may increase the remaining rhodamine B isothiocynanate dye at the injected site of the human dermal fibroblasts.