Advertisement

Proposal of a Noninvasive Method to Reduce Injection-Related Bruising in Aesthetic Medicine: Transillumination

  • Simone La PadulaEmail author
  • Barbara Hersant
  • Patrick Helynck
  • Mounia Mezi SidAhmed
  • Jean Paul Meningaud
Original Article Non-Surgical Aesthetic
  • 53 Downloads

Abstract

Background

Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications.

Material and Methods

We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used.

Results

TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046).

Conclusions

Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Aesthetic medicine Injections Fillers Vascular exploration methods Transillumination 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

Ethical approval was given, by FRENCH institutional committee and the relevant Judgement’s Reference Number is 2018-A03400-56. All procedures in the study involving human participants have been performed in accordance with the ethical standards of institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all participants.

Supplementary material

After the vessels had been detected on the side chosen for the TL technique, a skin-marker pencil was used to draw the vascular mapping of the part of the face to be treated. Injection was performer between the skin vessels projection drawings to reduce the risk of bruising and intravascular injection (MP4 124926 kb)

References

  1. 1.
    La Padula S, Hersant B, SidAhmed M, Niddam J, Meningaud JP (2016) Objective estimation of patient age through a new composite scale for facial aging assessment: The face—objective assessment scale. J Craniomaxillofac Surg 44:775–782CrossRefPubMedGoogle Scholar
  2. 2.
    Carruthers J et al (2014) Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 134:1197CrossRefPubMedGoogle Scholar
  3. 3.
    Sung MS, Kim HG, Woo KI, Kim YD (2010) Ocular ischemia and ischemic oculomotor nerve palsy after vascular embolization of injectable calcium hydroxylapatite filler. Ophthal Plast Reconstr Surg 26:289–291CrossRefPubMedGoogle Scholar
  4. 4.
    Tansatit T, Moon HJ, Apinuntrum P, Phetudom T (2015) Verification of embolic channel causing blindness following filler injection. Aesthet Plast Surg 39:154–161CrossRefGoogle Scholar
  5. 5.
    Coleman SR (2002) Avoidance of arterial occlusion from the injection of soft tissue fillers. Aesthet Surg J 22:555–557CrossRefPubMedGoogle Scholar
  6. 6.
    Li X, Du L, Lu JJ (2015) A novel hypothesis of visual loss secondary to cosmetic facial filler injection. Ann Plast Surg 75(3):258–260CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sun ZS, Zhu GZ, Wang HB, Xu X, Cai B, Zeng L, Yang JQ, Luo SK (2015) Clinical outcomes of impending nasal skin necrosis related to nose and nasolabial fold augmentation with hyaluronic acid fillers. Plast Reconstr Surg 136:434–441CrossRefGoogle Scholar
  8. 8.
    Park KY, Son IP, Li K, Seo SJ, Hong CK (2011) Reticulated erythema after nasolabial fold injection with hyaluronic acid: the importance of immediate attention. Dermatol Surg 37:1697–1699CrossRefPubMedGoogle Scholar
  9. 9.
    Kang MS, Park ES, Shin HS, Jung SG, Kim YB, Kim DW (2011) Skin necrosis of the nasal ala after injection of dermal fillers. Dermatol Surg 37:375–380CrossRefPubMedGoogle Scholar
  10. 10.
    Kim DW, Yoon ES, Ji YH, Park SH, Lee BI, Dhong ES (2011) Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. J Plast Reconstr Aesthet Surg 64:1590–1595CrossRefPubMedGoogle Scholar
  11. 11.
    Sung HM, Suh IS, Lee HB, Tak KS, Moon KM, Jung MS (2012) Case reports of adipose-derived stem cell therapy for nasal skin necrosis after filler injection. Arch Plast Surg 39:51–54CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Inoue K, Sato K, Matsumoto D, Gonda K, Yoshimura K (2008) Arterial embolization and skin necrosis of the nasal ala following injection of dermal fillers. Plast Reconstr Surg 121:127e–128eCrossRefPubMedGoogle Scholar
  13. 13.
    Tucunduva MJ, Tucunduva-Neto R, Saieg M, Costa AL, de Freitas C (2016) Vascular mapping of the face: B-mode and Doppler ultrasonography study. Med Oral Patol Oral Cir Bucal 21:135–141CrossRefGoogle Scholar
  14. 14.
    Michalek P, Donaldson W, McAleavey F, Johnston P, Kiska R (2013) Ultrasound imaging of the infraorbital foramen and simulation of the ultrasound-guided infraorbital nerve block using a skull model. Surg Radiol Anat 35(4):319–322CrossRefPubMedGoogle Scholar
  15. 15.
    Helynck P (2006) Transillumination in Phlébology: a study of the depth of penetration of transillumination; materials, methods and results. Phlebologie 59:309–317Google Scholar
  16. 16.
    Helynck P (2004) Recent advances in the use of transillumination in phlebology: sclerosis under transillumination; prophylactic sclerosis. Phlebologie 57:393–398Google Scholar
  17. 17.
    Lee GS (2015) Use of AccuVein™ for preventing complications from accidental venipuncture when administering dermal filler injections. J Cosmet Laser Ther 17:55–56CrossRefPubMedGoogle Scholar
  18. 18.
    Sorensen EP, Urman C (2015) Cosmetic complications: rare and serious events following botulinum toxin and soft tissue filler administration. J Drugs Dermatol 14:486–491PubMedGoogle Scholar
  19. 19.
    Schonauer F, Moio M, La Padula S, Molea G (2009) Use of preoperative Doppler for distally based sural flap planning. Plast Reconstr Surg 123:1639–1640CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of Plastic, Reconstructive and Maxillofacial SurgeryHenri Mondor HospitalCréteilFrance

Personalised recommendations