The “ART” of Facial Filler Injections: Avoid, Recognize and Treat Hyaluronic Acid‐induced Complications

Hyaluronic acid (HA) fillers are frequently used for cosmetic purposes as volumizers or as wrinkle fillers. One of the major advantages of hyaluronic acid use is the possibility to neutralize it by using hyaluronidase should complications occur. A case of a 21-year old female patient is presented, in whom a hyaluronic acid injection-induced vascular occlusion was seen four days after the initial injection, with increasing pain and severe signs of ischemia. Treatment consisted of an immediate hyaluronidase injection, supplemented with administration of acetylsalicylic acid, piracetam, low molecular weight heparin (LMWH), corticosteroids, analgesics, prophylactic antibiotics, application of topical nitroglycerin and warmth, smoking cessation and hyperbaric oxygen therapy. The initial progress and evolution of the deformity with possible therapeutic options is being discussed. We present the "ART" (avoid, recognize and treat) in handling filler complications as new universal guidelines for clinical aesthetic practitioners and injectors. Level of Evidence: Level V.