The time course and proper management of vascular occlusion attributable to interarterial hyaluronic acid fillers is critical. Albeit a rare complication, off-label uses of HA fillers, lack of proper training of injectors, and lack of clear appropriate guidelines in the management of these complications are some of the causes of delayed treatment and necrotic complications.
There are currently no definitive guidelines for the management of filler-associated cutaneous necrosis as experience with its treatment continues to evolve and be reported. In an attempt to consolidate the published data, as well as to give somewhat of a clear guideline of expectations, a time course and treatment guide has been outlined. The following is a working guideline for management of vascular occlusion attributable to HA fillers based on reports in the literature. This is not a consensus statement, rather it is a consolidation of the anecdotal reports and case studies outlined to help practitioners. It is also not inclusive of all the presentations of vascular occlusion. There are delayed cases of vascular occlusion beginning several days after injection, as well as alternative treatment options that may be considered.
These guidelines also are not for the devastating complication of blindness because of vascular occlusion secondary to fillers. Blindness is beyond the scope of the current article; however, we believe all experienced injectors should have emergency preparations in place and a relationship with an ophthalmologist or other trained surgeons experienced in performing retrobulbar hyaluronidase injections who can be reached in the event of a suspected occlusion. Any symptoms of eye pain, headache, or visual changes need to be immediately treated. Vascular occlusion is an emergency and timing is critical to prevent permanent blindness and facial deformities.
As with all filler injections, risks and complications can happen, and we cannot stress enough the appropriate level of training, as well as expert understanding of anatomy and injection technique, in minimizing potential risks. We encourage regulations and a required level of training to perform these procedures.
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