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A patient was treated with tear trough filler and developed a retrobulbar haemorrhage. This was managed acutely with a lateral canthotomy and cantholysis with no lasting visual compromise. This is the first reported case of an orbital compartment syndrome following filler injection and highlights the potential blinding complications which can occur. There should be an increased awareness of this complication amongst practitioners administering tear trough filler. [ABSTRACT FROM AUTHOR]

Filler injections have become very popular in recent years, and injectors globally use them for facial shaping and reversing age-related changes. Detailed knowledge about important vessels' and tissue planes' anatomy is essential for injectors. While giving the filler injections, injectors tend to gently pinch or pull the tissue fold with the nondominant hand during the procedure. The deformational forces cause some changes in the anatomy of tissue layers held in a pinch. During the pinch and "pinch and pull" maneuver, the crucial vessels in the area can get pulled up in the tissue layers in a pinch or stay in their position unaffected depending on the force applied. The "pinch and pull" maneuver also increases the tissue space for injections by moving the mobile tissue layers away from the fixed ones. The injector can use knowledge of the "'pinch anatomy" in the forehead to avoid important arteries and place filler in the correct plane. With the understanding of the anatomical changes occurring during the pinched state of tissue layers, filler injection can be performed in the right and safer tissue plane in the forehead. This study reflects level of evidence V. [ABSTRACT FROM AUTHOR]

Pre‐injection aspiration of hyaluronic acid filler is a well‐recognized yet controversial safety technique. Many consider aspiration to be an important safety measure to prevent inadvertent intravascular filler injection. To assess factors influencing pre‐injection aspiration by understanding the relationship between aspiration time and a range of product, needle, and procedural characteristics. We conducted a systematic review and meta‐analysis of data, adopting the preferred reporting items for systematic reviews and metaanalyses guidelines. Our literature search identified four articles presenting data on variables associated with aspiration time for different HA filler brands. Statistical models pooling data from the four articles suggest a robust association between aspiration time and a filler's elastic modulus (G′), drop weight (cohesivity), and cross‐sectional area of the needle lumen. However, there is insufficient evidence to confirm a robust association between aspiration time and HA concentration, viscous modulus (G″), needle length, and pullback volume. A deeper understanding of the relationship between product, needle, and procedural characteristics, and aspiration time can provide a sound base for discussing the role of pre‐injection negative aspiration as a safety measure. The understanding of the effect of various factors on preinjection aspiration would further benefit from studies under clinical conditions. [ABSTRACT FROM AUTHOR]

Filler injections have become exceedingly popular in the last decade, and injectors across the globe are using them for facial contouring and reversing the age‐related changes. Thorough knowledge about the anatomy of important vessels and tissue planes is essential for injectors. During filler injections, injectors generally tend to pinch or pull the tissues with the nondominant hand for the ease of the procedure. These deformational forces lead to some changes in the anatomy of tissue layers held in a pinch. During pinch maneuver, the important arteries in that region can get pulled up in the tissue layers held in a pinch or stay in their position unaffected. The pinch can also increase the tissue space for injections by moving the mobile tissue layers away from the fixed ones. Knowledge of this "pinch anatomy" in the temple can be used to the injector's advantage to avoid important arteries and to place filler in the correct plane. [ABSTRACT FROM AUTHOR]

The injection of hyaluronic acid (HA), a naturally occurring biopolymer, is a common cosmetic procedure. Despite their effcacy and growing adaptation by the medical community, HA fillers occasionally give rise to adverse events. Adverse events from HA fillers range from temporary, such as edema and erythema, to more longterm effects, including granulomas or, in rare cases, sequelae from vascular occlusion. Here, we present a case of a 61-year-old Caucasian woman with prolonged infraorbital hollow edema after injection of HA filler for nasojugal groove correction. We review the anatomy of the nasojugal area and differing injection techniques as a possible explanation for the development of prolonged edema. Similarly, the rheological properties of the specific hyaluronic acid used during this procedure might be crucial in the development of this complication. [ABSTRACT FROM AUTHOR]

Background Hyaluronic acid is generally accepted today as the “gold standard” filler agent, and its use has subsequently grown enormously. In addition, newer facial volume augmentation indications are constantly evolving. Rare adverse events, such as granulomas, have been described. However, complications are more commonly due to product misplacement or overcorrection leading to unsightly lumps and masses. Hyaluronidase treatment of these latter adverse effects can be both effective and rapid. Objective This paper aims to confirm the efficacy of hyaluronidase injections in dissolving unsightly hyaluronic acid overcorrection. Methods A case of hyaluronic acid overcorrection is described with evaluation of the effects of hyaluronidase. Results The use of hyaluronidase, injected intracutaneously permits the elimination of patient discomfort and inaesthetic lumps within a few hours. Conclusions Hyaluronidase is highly effective in eliminating HA volume overcorrection. [ABSTRACT FROM AUTHOR]