Rare Complication of Dermal Fillers: Case and Review Highlights Alopecia Risk and Management Strategies
Saudi Arabia: Dermal filler-induced alopecia is a rare yet significant complication arising from aesthetic procedures, primarily linked to vascular occlusion and subsequent tissue ischemia. While hyaluronic acid (HA) fillers are widely used for facial rejuvenation, their use can sometimes lead to serious adverse effects such as skin necrosis and hair loss, especially in high-risk areas like the temples and glabella. A recent case report and literature review published in the Journal of Cosmetic Dermatology highlight the clinical presentation, diagnostic approach, and management strategies for this uncommon but concerning condition.
The case concerns a 21-year-old female patient who presented with localized skin necrosis and alopecia just four days after receiving 7 mL of HA filler injections in her temples, tear troughs, and eyebrow glabella regions. Upon examination, trichoscopy revealed signs of follicular dropout and white dots, consistent with ischemic hair loss caused by reduced blood flow to the hair follicles. This case emphasizes the potential dangers of filler injections in areas with dense vascular structures, where inadvertent vascular occlusion can cause tissue damage leading to hair loss.
The treatment regimen included a combination of hyaluronidase injections (1500 units), intralesional corticosteroids, topical minoxidil, and CO2 laser therapy. Hyaluronidase, an enzyme that breaks down hyaluronic acid, addressed ischemia by reversing the effects of filler-induced vascular occlusion. Over one year, the patient experienced complete hair regrowth, and the facial scarring also resolved. This case illustrates the importance of early recognition and intervention in filler-induced alopecia, as prompt treatment can lead to full recovery and cosmetic restoration.
The literature review revealed that only 16 cases of filler-induced alopecia have been documented, with the majority of these cases involving HA fillers. The findings suggest that the risk of such complications is higher when filler injections are administered in high-risk areas, such as the temples, where large arteries and veins are located. This reinforces the need for careful consideration of injection techniques, including ultrasound guidance, to avoid vascular occlusion and minimize potential risks.
This case report serves as a reminder for dermatologists and aesthetic practitioners to be vigilant in recognizing the signs of filler-induced alopecia. Early detection and appropriate intervention are crucial to mitigating ischemic damage and promoting full recovery. By adhering to recommended injection techniques, proper dosages, and utilizing tools like ultrasound for guidance, the risks associated with dermal filler injections can be significantly reduced, ensuring safer outcomes for patients.
The authors concluded that while dermal filler-induced alopecia is a rare complication, it highlights the need for heightened awareness in aesthetic medicine. Through prompt and multidisciplinary management, patients can achieve significant cosmetic recovery, underscoring the importance of preventative measures in aesthetic procedures.
"Although rare, filler-induced alopecia requires increased vigilance from dermatologists and aesthetic practitioners. The risks can be minimized by following proper injection techniques, adhering to recommended dosages, and employing ultrasound guidance when appropriate, ultimately enhancing patient safety," they wrote.
Reference:
Albargawi, S., Nagshabandi, K. N., & Shadid, A. Dermal Filler-Induced Alopecia: A Case Report and Literature Review. Journal of Cosmetic Dermatology, e16684. https://doi.org/10.1111/jocd.16684
