Is the NHS equipped to manage complications?

Sir, there has been a recent rise in popularity of dermal fillers with the increased use of social media, video calling and conferencing since the start of the pandemic.¹ As personal care premises, such as beauty salons, have been able to re-open following the easing of COVID-19 restrictions, there has been a rise in the number of patients attending Accident and Emergency (A&E) departments, with vascular occlusion following the injection of filler material undertaken in these establishments.

Vascular occlusion is a rare, but severe, complication occurring due to inadvertent intravascular injection of dermal fillers, or external vascular compression. The incidence of a vascular occlusion following soft tissue augmentation with filler is 1 in 100,000.² It is more common in the glabella and nasal area due to the limited collateral blood flow,³ and has the potential to result in skin necrosis and tissue death if left untreated.² The first-line treatment for vascular occlusion is hyaluronidase, which is a prescription-only medication; it can break down hyaluronic acid, the component found in dermal fillers.⁴

Whether undertaken by medical or non-medical practitioners, it is vital that there is a clear protocol in place for the management of such complications before administering dermal filler. Many patients are referred to their local oral and maxillofacial surgery (OMFS) department once a diagnosis of vascular occlusion is made, but it is important to bear in mind that A&E departments and maxillofacial units may not necessarily be able to manage acute complications of facial aesthetic procedures. The maxillofacial dental core trainees receiving the referrals may not have advanced aesthetics knowledge and training. In addition, the hospital may not have hyaluronidase medication readily available.

As the public continue to seek facial aesthetic treatments, post-operative A&E attendances are also likely to rise. We believe it is important that A&E and OMFS teams are trained to spot these complications and be aware of onward specialist referral pathways, as appropriate, for the patient to receive the optimum level of care that is vital in these situations.