NECROSIS CASE REVIEW: Cheek filler infraorbital artery vascular occlusion [Aesthetics Mastery Show]
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- Опубликовано: 15 сен 2024
- Credit goes to Gillian Murray for the stages of ischaemia (referred to here as stages of necrosis) from her Vascular Occlusion Guideline 2019. More details: www.cmac.world/
In 2010 Julie Bass Kaplan, an experienced nurse injector from California, was herself treated with Radiesse in the mid face during a training session. Julie suffered an infraorbital artery vascular occlusion, and went on to experience all the stages of necrosis.
When a clinician shares their own personal experience of a complication, as Julie did so graciously in this case, it is a true gift to the rest of the medical aesthetics community, because we get to learn from very well documented images and a detailed breakdown of each stage of the complication.
In this week's Aesthetics Mastery Show, Dr Tim goes into detail about the clinical aspects of Julie's case, including:
- Explaining what the mottled rash - livedo reticularis - is and how to look out for it in your patients.
- Some important learning about how the needle's angle of entry might have contributed to the occlusion.
- Which other vessels might have been affected and why.
- And a detailed breakdown of the stages of necrosis, including images from Julie.
Thank you so much again to Julie for sharing her experience, and the invaluable learning for all of us that has come from that 🙏
IN NEXT WEEK'S SHOW: Dr Tim will be sharing his analysis of the lessons clinicians can learn from Julie's case, so make sure you subscribe and turn on notifications for that.
Here's the Instagram live Tim did with Julie where she described the case in her own words: www.instagram....
Follow Julie on Instagram here where she drops loads of value for fellow injectors: / jubilant.julie
Here is Julie's very helpful Patreon site: / juvedermjulie
Other useful links:
Facebook: / drtimpearce
Instagram: / drtimpearce
Website: drtimpearce.com/
Podcast: open.spotify.c...
Sign up to Dr Tim's free webinar about how to free yourself from complications anxiety: www.aestheticc...
#dermalfiller #medicalaesthetics #aesthetics
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![AVOID! The 5 Dangerous Arteries That Run Parallel To Your Needle/Cannula [Aesthetics Mastery Show]](/img/1.gif)
Thank you Dr. Pearce for your interview and for your education you constantly provide. I appreciate you! After our Instagram interview I shut my phone off and realized I felt even a little lighter. Thank you for the continued healing. Even 11 years later, my emotions can be right at the surface. I hope to meet you and your wife sometime soon. Hugs to you both, Julie
Thanks Julie for sharing! There are so many injectors that have a false sense of security. Invest in cadaver labs and Dr. Tim’s online complication course!
😭You felt lighter because you're helping heal the world, one truth at a time. 100% will happen one day!
Thanks again Julie for sharing. I recall when this first happened to you and I sent an email to you. You responded promptly and shared some info. As an injector I feel the importance of sharing knowledge and experience with our colleagues to prevent catastrophic outcomes. I can't believe this has been 10 years already! We had the same nurse injector from California come to our practice but being the type of person who likes to err on the side of caution, I do not use that product anymore.
Education like this is invaluable. Thank you all for sharing this information! I can’t tell you how much I take away from these videos, I’m so incredibly grateful ❤️
Hi Diyanah, that's SO wonderful to know, thank you for sharing.
Another excellent video from you both. Very scary and interesting that it was the adrenaline and not the large bolus of Radiesse that most likely caused this reaction. You two work so well together and I love your channel. Most educational! 👍
Thank you SO much, that means a lot a) that you got value b) your kind words. Thank you again
Much love to both of you from Chile 🇨🇱. I’m learning a lot and that makes me very happy 🥰. Thanks for sharing this content 👍🏻
I'm so happy to connect with you all the way to Chile, what an honour. Thanks Catalina!
She was the nurse that was on the Doctors show. alot were against her for speaking out thinking they know better, but it looks like she was really looking out for people not to destroy their faces. These things do happen, even if it's 1 in a 10000 (or more) even with professionals that's still 1 person's face scarred. It could happen more often but if it gets posted it gets deleted for being seen as "negative" (aka affecting commission money)
Thanks Dr Pierce for your amiability! Gretings from Argentina
Greetings to you too Gabriela 🙏
Thanks so much -very helpful to see pictures and progress .
Thank you so much for presenting this!
Thank you for watching, appreciate that.
Wait... so if there is a VO that’s all that happens??? Don’t get me wrong, I know that totally stinks to have happen, but I thought like… Well, I don’t know what I thought! I thought maybe you had to go to the hospital and they cut your cheek out or something like that🤷🏻♀️
As terrible as this is, I feel better about a vascular occlusion now. Now that I know it sucks, but you’re not going to die. Thanks so much for the information💋
They said she was lucky because only a little went into the vein to occlude, and they said blindness is possible, so I don't see how that's an only. Because it can't be dissolved, there was no point in going to the hospital. But yes, death is unlikely. Blindness and being deformed aren't.
@@NA._ yes, you are right. Defórmate and possible blindness can be a side effect. And for those getting cosmetic procedures, the goal is improvement. So even deformaties can be devastating.
if ha filler travels through your blood vessel to the retina of your eye...you will become permanently blind
I had even worse on both cheeks 7 weeks of hell
Sepsis and now max facial surgeon.Definately sue my face ruined forever.
This was AWSOME! Thank u guys. Have u guys thought about a Video about reversal protocoll for CaHa?
Hi Mauricio. Thanks loads for your kind words 🙏 Does such a thing as a CaHa reversal protocol exist? Isn't that the whole problem...we can't reverse :-( I might be wrong
@@mirandapearcemindset well, that is the thing. Radiesse for example is an extreme popular filler and there are some studies that say that sts may be helpful to reverse adverse effects like nodules . But in case of a VO....for example...there are no protocols. I guess julie caplan posted something about it on her IG, but it actually is like the same protocol for HA. Do u guys use Radiesse?
@@mauricioceronm.d.351 No. Tim used to years ago, but made a decision to stop. Interesting - I'll dig into Julie's thoughts on this. Thanks Mauricio!
You are welcome beauty.
@@mauricioceronm.d.351 😘
I want chin fillers but i heard it can travel in artey carrying oxygen to eye which may lead to blindness. i am so scared now ....pls help
Good evening. All dermal fillers have this risk. The risk is incredibly rare but a risk non the least. Choose your injector carefully. What would they do To support you should this happen.
Express your worries and if they make you feel at ease then they’re the practitioner for you. And if the risk is too great for you then it’s ok to say no!
Kind regards Mary. Clinical advisor for Dr Tim.
Thanks! I got necrosis on my forehead after hyaluron filler. It is almost healed but I got deep scars now. Will the scar disappear?
You need to tape it. There is other things you can do but idk. Get some silicone tape.
great info
Glad you found it useful Trina, thank you for the feedback.
Hello doctor
I have a very urgent question and help.
I had a patient yesterday. I injected her cheek by cannula 25g.
After 15 minutes, I say that small area turned a little to white colour.
6 followed up with her.she says that the area is painful and it's spread under the eye and near nose and today the area is pink colour And when she touches she feels some liquid .I said to her used warm compression. She felt better in pain
Should I inject Hyalase?
Kindly help doctor
I can't give you advice without seeing really, but you should see her face to face, if you think it's a VO then dissolve it.
Would it be safer to inject prf?
I wonder putting on steroid and antibiotic cream will help. At least , it will dampen the inflamation part
Actually Radiesse is not a bad product. I think it need to be diluted in order to be used
why?
I hope she sued that injector, this is insane
van Loghem recommends sodium thiosulfate- any thoughts?
www.dovepress.com/can-sodium-thiosulfate-act-as-a-reversal-agent-for-calcium-hydroxylapa-peer-reviewed-fulltext-article-CCID
It's not likely to help, and can cause necrotic injury itself according to this paper, so it does not seem likely that it is anywhere near as effective as hyalase for ha.
@@DrTimPearce Thanks for your reply, onus should be on Merz to find a suitable antidote!
@@bobasaurus508 I think it's unlikely that will happen, the product should be reserved for people with contraindications to Hyaluronic acid.
So it eventually healed instead of going necrotic even though it was VO! 🙀
He said only a small amount got into her vein. She was lucky it wasn't worse.
I’m not sure what this doctor is trying to convey, he’s not teaching how to avoid this. I remember in the past anyone would inject anywhere, danger areas ie nose, Nasolabial Folds, etc. The best thing one can do is have your blood vessels mapped before injection, if so you won’t have any problems. I’m not a doctor it’s just my experience and opinion