Prevention and Treatment of Vascular Complications in Cosmetic Injections

The prerequisites for vascular damage after injection are:

(1) The tissue is rich in blood supply;

(2) The parenchymal tissue is damaged;

(3) The local pressure rises sharply. The blunt needle is not easy to puncture the blood vessel and is a safer choice. However, blunt needles are not absolutely safe. If there are too many injections and local tension is too large, it is difficult for blood vessels to slide, and even blunt needles may puncture blood vessels. The effect of local cold compresses is to constrict blood vessels, making it difficult for the needle to enter the blood vessels, thereby reducing the possibility of injections entering the blood vessels.

Epinephrine can strongly constrict local blood vessels, and it can also avoid needle sticking into the blood vessels, but caution should be paid to contraindications such as high blood pressure when using it. It is particularly important to choose the appropriate injection level. The commonly used injection levels include the mid-to-deep dermis, subcutaneous tissue, and periosteum. The operator should select the appropriate injection level according to the anatomical structure and filling effect of the filling site, avoiding important blood vessels and nerves. . Generally speaking, when injecting the tear trough and infraorbital groove, the layer should be on the periosteum of the infraorbital rim; the orbitozygomatic region (commonly known as "apple muscle") should be injected on the periosteum to avoid the infraorbital artery; when injecting into the nasolabial fold , above the level of the nasal spine should be on the periosteum, below the level of the nasal spine should be in the subcutaneous layer to avoid the facial artery; the chin injection can choose the supraperiosteal and subcutaneous fat layers to shape the three-dimensional effect; the frontal injection should be on the periosteum or Superficial subcutaneous layer, avoiding the superficial temporal artery and vein and the middle temporal vein; nasal injection should be selected on the periosteum to avoid damage to the intrafascial blood vessels of the nasal dorsum. Before each injection, the empty needle must be withdrawn to determine whether it is outside the blood vessel.

Injection dose: one dose should not be too large, and a small amount should be injected multiple times; the injection force should not be too large, and it should be injected as gently as possible. When the patient suddenly experiences radiation pain, they should be highly vigilant for vascular injury; if there is a lot of bleeding, it should also be suspected whether the blood vessel is injured; at this time, the injection site should be changed to avoid repeated injections at the same point. The typical presentation of vascular embolism is pain and a change in skin color, which may appear pale, mottled, or blue-purple. Therefore, physicians should closely observe skin changes during injection, and detect possible vascular embolism in time. Once it occurs, local hot compresses should be applied to dilate blood vessels, steroid hormones, low molecular weight heparin sodium and aspirin drugs, as well as Salvia miltiorrhiza, papaverine, etc. Treatment: For individual severe cases, it is also necessary to use a hyperbaric oxygen chamber to save ischemic and hypoxic tissues. If it is clearly caused by hyaluronic acid, hyaluronidase should be injected at the injection site immediately, and antibiotics and antiviral drugs should be used to prevent infection if necessary. Once the signs of ophthalmic artery embolism appear or are suspected, an ophthalmologist should be consulted in time for timely detection and early treatment. In short, although the probability of vascular complications is low, if they occur, the consequences are usually more serious, so more attention should be paid. There are many types and brands of injection materials currently available for clinical use. Each injection material has its own relatively special risk of complications, and the injection requirements are often different. Before each injection, the anatomical structure of the injection site should be clarified; detailed medical history should be inquired, contraindications should be excluded, and risks should be minimized; appropriate injection materials should be selected, correct injection techniques should be mastered, and adequate preparations should be made to avoid absolute risk. Most complications occur.

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