Guide for Managing Vascular Occlusion Caused by Fillers with Exclusive Cutaneous Involvement: A Review of Diagnosis, Classification, and Treatment.

Introduction: Prompt management of vascular occlusion from hyaluronic acid (HA) fillers is crucial to prevent permanent tissue damage. This study reviews key factors influencing clinical outcomes-excluding ocular cases-and evaluates current protocols and modern treatment strategies METHODS: A systematic literature review was conducted to develop an action guide for managing vascular occlusion, focusing on both technical and pharmacological aspects. The search prioritized publications with significant clinical impact and expert guidelines, excluding older studies to ensure alignment with modern angiosome concepts and recent advancements in interventional radiology. The review, conducted using PubMed, identified 96 relevant articles. Keywords included "Dermal Fillers", "Vascular Occlusion", and "Complications".

Results: Pain and skin color changes are the most prevalent signs of vascular occlusion. Immediate intervention within the first 4-6 h significantly improves prognosis, with early-stage ischemia being reversible in up to 80% of cases. A structured classification system, incorporating the FOEM2 score and ischemic staging, enables precise treatment decisions. High-dose HYAL (1500 IU), administered every 15-20 min, remains the primary treatment, with ultrasound guidance reducing required doses by up to tenfold. Antiplatelet therapy mitigates HA-induced platelet aggregation. Corticosteroids control the inflammatory response, while vasodilators are reserved for post-resolution perfusion improvement. Hyperbaric oxygen therapy enhances tissue oxygenation, supporting ischemic recovery.

Conclusion: Accurate and timely diagnosis, along with prompt intervention using protocols based on current angiosome concepts and advanced techniques, is crucial for managing vascular occlusions. Establishing standardized guidelines will enhance patient safety and treatment efficacy in aesthetic medicine.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .