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Broken Needle Retrieval Following Periorbital Soft-Tissue Filler Injection

Noh, Stephanie H. B.A.*; Joseph, Jeffrey M. M.D., F.A.C.S.; Tao, Jeremiah P. M.D., F.A.C.S.

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Ophthalmic Plastic and Reconstructive Surgery: July/August 2020 - Volume 36 - Issue 4 - p e108
doi: 10.1097/IOP.0000000000001495
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We report a complication of needle breakage and retention in the facial soft tissues following hyaluronic acid gel filler administration. A 34-year-old female with no past ocular or medical history presented with pain and hypoesthesia to her medial right lower eyelid one day after filler injection to the tear trough elsewhere. The injecting provider indicated that the distal end of the needle broke off near the inferior orbital rim area and was not retrieved. CT imaging without contrast demonstrated a radio-opaque foreign object consistent with a needle in the malar soft tissues on coronal (Fig. 1A), sagittal (Fig. 1B), and axial (Fig. 1C) views (white arrowheads). The needle appeared to reach the level of periosteum and was concerning for infraorbital nerve involvement. After the filler was dissolved using hyaluronidase, open surgical exploration was recommended. Through a transconjunctival lower eyelid approach (Fig. 2A), the hub of a 32-gauge needle was evident embedded in the root of the infraorbital neurovascular bundle. The needle was surgically retrieved without complication and measured approximately 12 mm in length (Fig. 2B). The patient recovered well postoperatively with improvement of her symptoms and normal eyelid positioning. In the literature, 30-gauge needle breaks have been reported during inferior alveolar nerve blocks. To the authors’ knowledge, there are no reports of larger gauge needles breaking off in the soft tissue during filler injection. Further research is necessary to determine if gauge size is a factor.

FIG. 1.
FIG. 1.:
CT scan without contrast. Coronal (A), sagittal (B), and axial (C) views of CT maxillofacial demonstrating the needle embedded in the malar soft tissues (white arrowheads).
FIG. 2.
FIG. 2.:
A, Intraoperative photograph of needle retrieval. B, Needle retrieved without complication measuring approximately 12mm in length.
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