The Force Required to Inject a Column of Filler Through Facial Arteries.
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
7
11
2019
medline:
6
1
2021
entrez:
6
11
2019
Statut:
ppublish
Résumé
Injectable fillers have become an integral part of facial rejuvenation, but vascular occlusion is a dreaded complication of such injections. To determine the force required by the fingertip onto the plunger of the syringe to cause retrograde migration. In this cadaver study, twelve 2-cm arterial segments and 4 fillers were tested. Injection pressure required to force a column of filler for 1 cm was measured. Five oculoplastics specialists were subsequently recruited and asked to inject the filler at a typical injection pressure. The nonhyaluronic acid filler required significantly more pressure to cause propagation of the material compared with all other fillers (p < .01). None of the other fillers differed significantly from each other. Typical injection pressures generated by experienced injectors were significantly lower than that required to cause propagation of filler at the desired velocity and significantly lower than mean arterial pressure. Measured pressure required to cause filler propagation was well within the normal range of the finger strength that can be generated by humans. Typical injection pressures from fingertip to plunger are lower than required to cause propagation of filler intravascularly.
Sections du résumé
BACKGROUND
Injectable fillers have become an integral part of facial rejuvenation, but vascular occlusion is a dreaded complication of such injections.
OBJECTIVE
To determine the force required by the fingertip onto the plunger of the syringe to cause retrograde migration.
METHODS
In this cadaver study, twelve 2-cm arterial segments and 4 fillers were tested. Injection pressure required to force a column of filler for 1 cm was measured. Five oculoplastics specialists were subsequently recruited and asked to inject the filler at a typical injection pressure.
RESULTS
The nonhyaluronic acid filler required significantly more pressure to cause propagation of the material compared with all other fillers (p < .01). None of the other fillers differed significantly from each other. Typical injection pressures generated by experienced injectors were significantly lower than that required to cause propagation of filler at the desired velocity and significantly lower than mean arterial pressure. Measured pressure required to cause filler propagation was well within the normal range of the finger strength that can be generated by humans.
CONCLUSION
Typical injection pressures from fingertip to plunger are lower than required to cause propagation of filler intravascularly.
Identifiants
pubmed: 31688236
doi: 10.1097/DSS.0000000000002248
pii: 00042728-202009000-00008
doi:
Substances chimiques
Dermal Fillers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e32-e37Références
Sundaram H, Liew S, Signorini M, Vieira Braz A, et al. Global aesthetics consensus: hyaluronic acid fillers and botulinum toxin type A—recommendations for combined treatment and optimizing outcomes in diverse patient populations. Plast Reconstr Surg 2016;137:1410–23.
Carle MV, Roe R, Novack R, Boyer DS. Cosmetic facial fillers and severe vision loss. JAMA Ophthalmol 2014;132:637–9.
Ramesh S, Fiaschetti D, Goldberg RA. Orbital and ocular ischemic syndrome with blindness after facial filler injection. Ophthal Plast Reconstr Surg 2018;34:1.
Chang SH, Yousefi S, Qin J, Tarbet K, et al. External compression versus intravascular injection. Ophthal Plast Reconstr Surg 2016;32:261–6.
Carruthers JDA, Fagien S, Rohrich RJ, Weinkle S, et al. Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 2014;134:1197–201.
Tansatit T, Moon HJ, Apinuntrum P, Phetudom T. Verification of embolic channel causing blindness following filler injection. Aesthet Plast Surg 2015;39:154–61.
Ugradar S, Hoenig J. Measurement of the force required by blunt-tipped microcannulas to perforate the facial artery. Ophthal Plast Reconstr Surg 2019;35:444–6.
Swanson AB, Matev IB, de Groot G. The strength of the hand. Bull Prosthet Res 1970;10:145–53.
Beleznay K, Carruthers JDA, Humphrey S, Jones D. Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg 2015;41:1097–117.
Alvarez-Alvarez FA, González-Gutiérrez HO, Ploneda-Valencia CF. Safe gluteal fat graft avoiding a vascular or nervous injury: an anatomical study in cadavers. Aesthet Surg J 2019;39:174–84.
Sundaram H, Voigts B, Beer K, Meland M. Comparison of the rheological properties of viscosity and elasticity in two categories of soft tissue fillers: calcium hydroxylapatite and hyaluronic acid. Dermatol Surg 2010;36(Suppl 3):1859–65.
Cho KH, Dalla Pozza E, Toth G, Bassiri Gharb B, et al. Pathophysiology study of filler-induced blindness. Aesthet Surg J 2019;39:96–106.
Khan TT, Colon-Acevedo B, Mettu P, DeLorenzi C, et al. An anatomical analysis of the supratrochlear artery: considerations in facial filler injections and preventing vision loss. Aesthet Surg J 2017;37:203–8.
Egbert JE, Paul S, Engel WK, Summers CG. High injection pressure during intralesional injection of corticosteroids into capillary hemangiomas. Arch Ophthalmol 2001;119:677–83.
Cowman MK, Schmidt TA, Raghavan P, Stecco A. Viscoelastic properties of hyaluronan in physiological conditions. F1000Research 2015;4:622.
Wu S, Pan L, Wu H, Shi H, et al. Anatomic study of ophthalmic artery embolism following cosmetic injection. J Craniofac Surg 2017;28:1578–81.
Huang H, Zhang J, Sun K, Zhang X, et al. Effects of repetitive multiple freeze–thaw cycles on the biomechanical properties of human flexor digitorum superficialis and flexor pollicis longus tendons. Clin Biomech 2011;26:419–23.