BC03: Facial subcision and SkulptraTM cosmetic fillers: a damaging combination?
T. Tull, W. Alwan and E. Craythorne
St John’s Institute of Dermatology, London, UK
Subcision refers to an incisionless technique whereby a needle or blade is used to dissect dermal and subcutaneous tissue, and can be useful for the treatment of scarring. We present the case of a 59-year-old woman who was referred to our unit with severe right-sided facial swelling and numbness following facial subcision to treat acne scarring. The patient had received cosmetic fillers for many years, initially with hyaluronic acid and then with SkulptraTM, with annual injections between 2017 and 2019. She underwent a Taylor Liberator subcision procedure in August 2020. Shortly after the procedure she developed bilateral facial swelling that was much more pronounced on the right side. An ultrasound confirmed a haematoma and an evacuation was attempted. The patient experienced ongoing swelling and numbness on the right medial cheek, which was present 8 weeks after the procedure, when she was initially seen in our clinic. On examination, she had prominent right-sided facial swelling and loss of sensation in the distribution of the right infraorbital nerve. Magnetic resonance imaging (MRI) revealed multiple foci of signal abnormalities in keeping with previous cosmetic fillers. These were present on the right superficial muscular aponeurotic system, but nodular thickening was also seen in the zygomaticus musculature and accessory parotid tissue. An extensive deep inflammatory response was seen in the subcutis and fascia on the right side. An area of hypointensity in keeping with resolving haematoma was present over the right zygomatic arch and tracked to the origin of the right infraorbital nerve. Given the inflammatory response seen on the MRI and ongoing facial swelling a tapering course of prednisolone was given. To our knowledge, the use of Taylor Liberator subcision in patients with Skulptra cosmetic fillers has not been reported in the literature. Owing to the deep fibrosis and anatomical distortion caused by this type of cosmetic filler, we propose that subcision should be performed with caution in patients previously treated with Skulptra.
