@aestheticsgroup
@aestheticsjournaluk
Aesthetics
aestheticsjournal.com
overview, which are discussed in more detail below and in the ACE Group World paper titled ‘Management of a Vascular Occlusion Associated with Cosmetic Injections’.1
Pain Bruising is caused by extravasation of blood when a vessel is injured by trauma and often associated with some pain or discomfort at the time of injury; although, bruising on its own does not normally cause a significant or prolonged amount of pain when caused by facial aesthetic injections.1 When body tissue is starved of blood and oxygen, as in the case of a VO, this causes hypoxia and a tissue response which is a painful phenomenon. During or following a dermal filler treatment, if the patient experiences an undue amount of pain, the practitioner should be mindful of the possibility of a VO.1 It should be noted that dermal Dr Martyn King provides an introduction to fillers containing local anaesthetic and differentiating between a bruise and a vascular the use of topical anaesthetic prior to treatment can mask the pain sensation occlusion when performing dermal filler treatments of a VO. Therefore, if you are using these Bruising is not uncommon for patients when having a dermal pain management techniques, be mindful that this symptom is a less filler treatment and is usually mild and self-limiting. However, it is reliable marker when assessing for a VO.1 essential that bruising is not confused with a vascular occlusion (VO) or vice-versa. A VO needs immediate management and a delay in Colour the diagnosis or treatment could have devastating consequences If dermal filler is injected intravascularly, this will often initially flush for the patient. the blood out of the vessel, resulting in a change of colour and paler VOs are a rare complication of dermal filler treatments, with an appearance along the course of the vasculature in a reticulated or net incidence of 1 to 10 cases per 100,000 treatments.1 However, due like pattern. Practitioners need to be vigilant whilst injecting to look to the rising popularity of dermal filler treatments as well as nonfor this sign because at this stage, stopping injection and attempting medical practitioners, we are observing an increase in the number aspiration, as well as applying heat, and vigorous massage may be all of complications. The Aesthetic Complications Expert (ACE) Group that is required to prevent a VO.1 Blanching can be more difficult to see World is currently helping to diagnose and manage two to three VOs in darker skin types, but there will usually still be a change in colour each week – sometimes more. It is also worrying that there are many in a characteristic pattern which should not be missed. Additional practitioners who are wrongly diagnosing bruises as a VO. Even more signs and symptoms of a VO may need to be relied on more for skin concerning is when a practitioner has believed the skin’s appearance of colour. A VO will often initially result in a paler, dusky appearance to be bruising when in fact, it’s a VO and its correct management has to the skin along the course of the affected blood vessel. As hypoxia been delayed or missed causing severe long-term damage. and tissue compromise occurs over the following hours and days, the As medical aesthetic practitioners, it’s imperative that you educate tissue often becomes more reddish-purple due to the accumulation yourself about correct diagnosis. There are several signs and of deoxygenated blood cells and tissue death. Although it will still symptoms that can be used to help differentiate between a bruise and have a characteristic pattern, the area of colour change will not just a VO which all practitioners should be aware of. See Table 1 for an include the vasculature itself, but the surrounding tissue that had been perfused by the blood vessel.1 Characteristic Bruising VO In contrast, bruising will at first appear reddish-purple, before becoming purplePain At time of injection only Escalating discomfort and pain over time black in colour. As it resolves, it may Colour (immediate) Reddish-purple Blanching and pallor become greener then yellow.1
Bruising vs Vascular Occlusion
Colour (hours to days)
Green to yellow
Red and possibly crusting
Pattern
Well demarcated
Reticulated
Blanching with pressure
No
Yes
Timing
May be delayed
Often immediate
Table 1: Signs and symptoms to look out for when administering dermal fillers1
Pattern The hallmark of a VO is the pattern of discolouration which follows the blood supply and is often described as reticulated. It is important that practitioners performing dermal filler
Reproduced from Aesthetics | Volume 8/Issue 8 - July 2021
