Valeria Álvarez-Rivero, Departamento de Dermato-Oncología y Cirugía Dermatológica, Centro Dermatológico “Dr. Ladislao de la Pascua”, Ciudad de México, México
Daniel Alcalá-Pérez, Servicio de Dermato-Oncología y Cirugía Dermatológica, Centro Dermatológico “Dr. Ladislao de la Pascua”, Ciudad de México, México
Objective: To identify the topographies with the highest risk of presenting vascular complications after the application of hyaluronic acid dermal fillers, and their most frequent clinical manifestations, and to also introduce a therapeutic algorithm with the required materials for an improved prognosis. Method: A systematic review and the development of a therapeutic algorithm based on the findings. The digital data search was carried out in multiple databases (PubMed, Scopus, SciELO, LILACS) from January 2011 to January 2022. The search terms were “vascular complications’’ and “facial fillers’’. Case series and case reports were included. Complications due to other than hyaluronic acid filler materials, studies focused on complications other than vascular, studies not focused on therapeutics, and studies with no available results were all excluded. Results: The analysis included 39 patients, reported in 27 articles. Rhinomodeling was the procedure most associated with vascular complications (38.4%) with onset of symptoms within seconds of application (38.4%). Skin tone changes (89.7%) and pain (64.1%) were pivotal symptoms for the early diagnosis of vascular occlusion. The mainstay of treatment in 64.1% was hyaluronidase; nonetheless, the dose is not yet standardized. Although no sequelae were reported in 46.1%, permanent blindness was the most serious consequence (12.8%). Conclusions: Hyaluronic acid facial fillers are one of the most popular aesthetic procedures worldwide; with their exponential increase, their complications have also increased. The need for a standardized strategy to appropriately manage vascular complications due to this material is crucial.
Keywords: Vascular complications. Facial fillers. Hyaluronic acid. Algorithm.