Successful Hyperbaric Oxygen Therapy In Complications Of Fillers Rhinoplasty-Cases Report

摘要

A total of 4 cases with complications following filler rhinoplasty referred to plastic surgery with hospital out-patient division. They were between 20 to 40 years old and only one man involved. They felt extremely painful during injection. Initially the skin lesion was blanching, discoloration, hyperemia and bruising. They were treated with oral antibiotic, non-steroid anti-inflammatory drug (NSAID) and hyperbaric oxygen therapy (HBOT) at 2.0-2.5 ATA (absolute atmosphere), 80 -120 minutes for 2 to 8 sessions. The times of session were according to the outcome after every session. The outcome of treatment for three of the cases was satisfactory. In one case the treatment led to failure. Necrosis developed because of delay referral. Complete wound healing was achieved with early recognition and institution of treatment. Introduction Use of dermal fillers for rhinoplasty has become an integral part of aesthetic practices. There are many options for use with fillers including Calcium hydroxylapatite (CaHA), hyaluronic acid (HA), collagen, poly-L-lactic acid (PLLA) and botulism. Those are popular used in Taiwan but only HA has antidote if an undesirable outcome occurs. The growing complications in filler injection occur ranging from mild bruising, blanching, hyperemia, violaseous to severe injection ischemia and even necrosis1,2. HBOT used as an adjunctive therapy to treat injection ischemia and prevent this complication. Case Report Case 1:43-year-old male healthy patient experienced immediate pain and blanching after HA injection. Left nasolabial fold and gingiva were hyperemic, his nasal tip was violaceous. There was concern for impending necrosis (figure 1a). He was under oral antibiotics, NSAID control. He accepted HBOT at 2-2.5 ATA, 80-120 minutes daily for total 15 sessions (Figure 1b). Non-surgical debridgement is needed and completely recovery.Case 2:A healthy 23-year-old female presented to our office four days after having 0.6cc of Calcium hydroxylapatite filler injection by an outside clinic. She previously had filler rhinoplasty a year ago with no complications. She felt intense pain and blanching initially on the right side of her face. Her face including nose, cheek, upper cutaneous lip, and chin was tender and hyperemic. Her nasal tip was violaceous (Figure 2a).She was under oral antibiotic control and has 2 sessions of HBOT at 2.5ATA, 80-90 minutes daily (Figure 2b). Unfortunately her nasal tip developed to full thickness of necrosis and then she was hospitalized for surgical debridgement. (Figure 2c)Case 3:42-year-old healthy women referred from outside clinic because of developing hyperemic, reticular pattern and of her nose after CaHA injection 3 days ago (Figure 3a).She received total 7 sessions of HBOT at 2.5ATA,80-120 minutes and completely recovery without surgical debridgement (Figure 3b,3c).Case 4:20-year-old female developed unilateral nasal blanching and intense pain following a HA injection. She was referred at next days because of developing hyperemic lesion. She received oral antibiotics control and 2 sessions of HBOT at 2.5ATA, 80-90 minutes. Complete recovery without scarring.