Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;14(5):E61-E69.
Epub 2021 May 1.

Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion

Gillian Murray  1   2   3   4 , Cormac Convery  1   2   3   4 , Lee Walker  1   2   3   4 , Emma Davies  1   2   3   4
Affiliations

Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion

Gillian Murray et al. J Clin Aesthet Dermatol. 2021 May.

Abstract

Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for the patient. The occurrence, and subsequent management, of these negative outcomes is a source of significant stress to the aesthetic clinician. Complications management is an essential component of clinical practice and professionals must develop competence and confidence in the identification and effective treatment of a vascular occlusion. The relatively rare occurrence of a vascular occlusion mandates that learning must be largely through the study of theory in addition to the sharing of learning experiences within a collaborative clinical community. The delivery of optimal care begins with an understanding of the underlying pathophysiology and the ability to assess and elicit clinical signs. Establishing a clinical diagnosis, targeted therapy can commence in a timely fashion. This paper provides guidance on how to identify and manage a vascular occlusion caused by cross-linked hyaluronic acid. It provides a detailed description of the pathological process of tissue ischemia, and introduces identifiable stages which will help to determine the extent of ischemia and the time frame since ischemic onset. The stages are particularly important as they highlight when wound support may be needed.

Keywords: Vascular occlusion; complication; cross-linked hyaluronic acid; dermal filler; filler; hyaluronic acid; hyaluronidase; necrosis; non-surgical.

PubMed Disclaimer

Conflict of interest statement

FUNDING:No funding was provided for this article. DISCLOSURES:The authors report no conflicts of interest relevant to the content of this article.

Figures

FIGURE 1.
FIGURE 1.
FIGURE 2A.
FIGURE 2A.
FIGURE 2B.
FIGURE 2B.
FIGURE 2C.
FIGURE 2C.
FIGURE 2D.
FIGURE 2D.
FIGURE 2E.
FIGURE 2E.
FIGURE 3.
FIGURE 3.
FIGURE 4.
FIGURE 4.
See this image and copyright information in PMC

References

    1. Belezney K, Carruthers J, Humphrey S et al. Update on avoiding and treating blindness from fillers: A recent review of the world literature. Aesthet Surg J. 2019;39(6):662–674. - PubMed
    1. Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinol tolerance time. Opthalmology. 1980;87(1):75–78. - PubMed
    1. Tobalem S, Scultz JS, Chronopoulos A. Central retinal artery occlusion-Rethinking retinal survival time. BMC Ophthalmol. 2019;18(1):101. - PMC - PubMed
    1. Delorenzi C. New High Dose Pulsed Hyaluronidase Protocol for Hyaluronic acid filler vascular events. Aesthet Surg J. 2017;37(7):814–825. - PubMed
    1. Taylor GI, Shoukath S, Gascoigne A et al. The functional anatomy of the opthalmic angiosome and itsimplications in blindness as a complication of cosmetic facial filler procedures. Plast Reconstr Surg. 2020;146(4):745. - PubMed

LinkOut - more resources