Critical Ischemia Following Hyaluronic Acid Filler Injection: A Case Report

Background: Vascular complications, following the application of non-permanent, hyaluronic acid-based tissue fillers are a rare but very serious and rapidly progressive disorder that can, in extreme cases, lead to skin necrosis, blindness, or a stroke. Interest in aesthetic procedures is constantly growing, so awareness and knowledge of the correct and comprehensive treatment of complications are important. The human face is an area characterised by complex innervation and vascularisation. There are high-risk areas in which the application of fillers should be carried out with particular care using appropriate techniques and instruments, as well as preparations with specific rheology. The aetiopathogenesis of vascular complications is complex-involving partial or complete vessel occlusion, the presence of local inflammation in the affected tissues, and potential arteriospasm of the vessels supplying the area, resulting in tissue dysperfusion and ischaemia. Methods: In this article, the case of a patient who developed signs of a vascular compromise on the forehead area after improperly administering filler in the glabellar and nasal areas is presented. Result: The diagnostic and therapeutic management applied, including above all high doses of hyaluronidase, Doppler ultrasound diagnostics, and general medications, as well as a complementary treatment of the distant effects of the complication, i.e., erythema and tissue loss in the forehead area, by autologous injection procedures and laser therapy, resulted in a full recovery and a very good aesthetic result. Conclusions: This case proves that complications after aesthetic medicine procedures, including vascular complications are possible. Education of patients and doctors, proper diagnosis, and initiation of appropriate treatment at an early stage of the problem can bring very good therapeutic results for the patient.