Case series of tongue necrosis from vascular complications after chin augmentation with hyaluronic acid: Potential pathophysiology and management

• Published in: Journal of cosmetic dermatology 2023-03, Vol.22 (3), p.784-791
• Main Authors: Thanasarnaksorn, Wilai, Thanyavuthi, Apichaya, Prasertvit, Piyatida, Rattanakuntee, Siwakorn, Jitaree, Benrita, Suwanchinda, Atchima
• Format: Article
• Language: English
• Subjects: Asymptomatic; Chin; chin augmentation; Cosmetic Techniques; Dermal Fillers; Drug dosages; Emergency medical care; filler injection; Humans; Hyaluronic Acid; hyaluronidase; Hyaluronoglucosaminidase; Ischemia; Mouth; Necrosis; Pain; Tongue; tongue necrosis; vascular complication; Vascular occlusion
• ISSN: 1473-2130; 1473-2165
• DOI: 10.1111/jocd.15475

Background Even though the chin is considered a safe injection area for facial filler augmentation, tongue necrosis is a rare complication in this area. Objective Our aim was to present case series of rare complications from chin filler augmentation with possible pathophysiology and management. Methods From our thorough literature search found only one case report of tongue necrosis from chin filler augmentation. We present case series of unilateral tongue necrosis from vascular occlusion following hyaluronic acid injection in the chin, which was successfully treated with a high‐dose hyaluronidase injection resulting in complete recovery in all patients. Results Variation in vascular anastomosis leads to a possible cause of vascular occlusion. The lingual artery is the primary arterial supply for the tongue, which is an exclusive target for embolism. Two main responsible arteries and branches are the deep lingual and sublingual arteries. The submental artery variation was previously described as the cause of this event. We proposed potential pathophysiology of the occlusion, not only the variation of vasculature but bone. The midline lingual foramen, an anatomical bone variation on the surface of the midline inferior jaw, was found to be another possible cause. This foramen contains a branch of the submental and sublingual artery, which includes the perforating artery, median perforating artery, or both. Filler injection with a sharp needle on the bone can potentially increase the risk of this vascular incident. A high dose of hyaluronidase administered with multiplane injections was accomplished with complete recovery. Conclusions Tongue necrosis from vascular complications after hyaluronic acid filler injection can occur. Not only vessels but bone variation pathology were possible causes.