Journal of Asia Pacific Aesthetic Sciences

Brendon Khye Chiat Chong

Abstract: Hyaluronic acid (HA) filler treatment is gaining popularity worldwide. As more filler treatments are performed, filler related complications are also rising. Vascular occlusions following HA filler is a rare complication which can cause significant morbidity to patients if it is not treated early. Here, we describe two separate patients who developed intravascular occlusion of the facial artery following HA filler treatment. Both patients were treated with HA filler over the nasolabial fold complicated with intravascular injection. The first patient was treated within 1 hour while the second patient was treated within 16 hours. The first patient developed skin blanching and was immediately treated with hyaluronidase. Second patient was treated with hyaluronidase with partial resolution of symptoms and required a second session of hyaluronidase the next day for complete resolution of symptoms. In both cases, hyaluronidase was flooded around the affected area and some amounts were injected into the affected vessel. Both patients were treated successfully without any long-term sequelae. Vascular occlusion can cause severe adverse events and if not treated early, can lead to serious long-term sequelae. Therefore, it is important for physicians to look out for signs and symptoms of intravascular occlusion and initiate treatment as soon as possible. Early and complete dissolution of the offending HA determines the success of hyaluronidase treatment.