LAUSR

SUMMARY The incidence of vascular occlusion injuries has risen substantially due to the increasing popularity of cosmetic injectables. Among these occurrences, instances of soft tissue ischemic events following the injection of non-particulate solutions, such as botulinum, represent an enigmatic etiology that has yet to be fully understood. One hypothesized mechanism of injury underlying these events relates to the accidental capture and intravascular ejection of needle micro-cores, defined as submillimeter tissue fragments trapped by the beveled lumen of a needle during conventional injections. To test this hypothesis, we conducted a cytologic evaluation of dermal remnants incidentally captured by 31G tuberculin needles following repeated injections into post-rhytidectomy skin fragments. Our findings revealed the presence of dermal tissue micro-cores ranging from 100-275 μm in diameter with an overall micro-coring incidence of 0.7%. These findings confirm the ability of ultra-fine needles, commonly employed in botulinum injections, to produce tissue micro-cores that may serve as causative agents of vascular occlusion with non-particulate solutions. Awareness of this additional mechanism of injury may be of benefit in the early recognition and management of these rare occurrences.