Hyperbaric oxygen therapy for treatment of vascular occlusion after permanent dermal filler injection

Arterial vascular occlusion is a rare complication of dermal filler injection. This case report describes the successful use of hyperbaric oxygen therapy in a patient with vascular occlusion after a permanent dermal filler was injected.

A 51-year-old woman underwent an injection of non-resorbable polymethylmethacrylate microspheres into her nasolabial folds. Several hours later, she experienced dusky discoloration of the right nasolabial fold and surrounding livedo skin changes, consistent with vascular occlusion. Treatment with warm compresses and topical nitroglycerin was initiated, and the patient was referred for hyperbaric oxygen therapy. The tissue discoloration improved significantly after the administration of six hyperbaric treatments.

While hyaluronidase is recognized as a treatment option for vascular occlusion associated with using temporary fillers containing hyaluronic acid, it may also be beneficial for patients who experience vascular occlusion after administration of permanent fillers. Hyperbaric oxygen therapy, which results in hyperoxygenation of ischemic tissue and mitigation of the associated inflammatory response, may also benefit patients who experience vascular occlusion after permanent filler injection.

Administration of hyaluronidase and hyperbaric oxygenation should be considered for patients who develop arterial occlusions after dermal filler placement, regardless of the type of injected filler.