Title : Tongue ischemia post filler injection: A case report and literature review
Abstract:
Hyaluronic acid (HA) fillers, though popular and generally safe for facial rejuvenation, can lead to severe complications such as vascular occlusion, resulting in skin necrosis, vision loss [1], and even strokes[2]. Effective treatments include the use of hyaluronidase to dissolve the fillers, hyperbaric oxygen therapy (HBOT) to enhance tissue oxygenation and the application of emergency management algorithms for prompt intervention[3]. Recent studies emphasise early recognition, structured treatment and understanding facial vascular anatomy is crucial for preventing and managing these complications, ensuring better patient outcomes[4].
Case Report:
A 31-year-old female with no significant past medical history presented with ischemic changes in the skin and the right side of the tongue after chin augmentation with HA. These changes were characterized by pallor and decreased perfusion in the affected areas. Hyaluronidase promptly was initiated; however, the ischemic changes did not ameliorate. Computer Tomography angiogram demonstrated a patent right lingual artery, ruling out complete arterial occlusion as the cause of ischemia.
Given the potential risk of airway compromise due to swelling and the need for close monitoring of the ischemic changes, the decision was made to admit the patient for overnight observation. During the stay, the patient's condition remained stable, with no progression of ischemic changes or airway compromise.
The patient was discharged the following day with instructions for close follow-up with her cosmetic doctors. The plan included further administration of hyaluronidase to address any residual filler material and to mitigate the ischemic changes.
Conclusion:
Tongue ischemia post HA filler injection is a rare but serious complication. Knowledge of facial vascular anatomy, cautious injection practices, and immediate management of ischemic events are essential to minimize risks. Continuous research and education are imperative for enhancing patient safety in cosmetic surgery.
