Background:
The upgrowing offer of Filler treatments for medical and esthetical purposes also increases the frequency of its complications. The most feared complication of hyaluronic acid (HA) Filler injections is vascular occlusion possibly leading to tissue necrosis and consequent loss of vital tissue. The only established treatment method so far is the uncontrolled injection of high doses of Hyaluronidase, which is often accompanied by pain and many unnecessary punctures leading to even more tissue stress or damage. For this purpose, ultrasound is an uncomplicated, radiation-free and excellent medical tool to identify the exact location of the occlusion and aid in precisely guided, controlled and tissue sparing treatment with the antidote..
Observation:
We present two cases of middle-aged women who suffered the complication of vascular occlusion after treatment with hyaluronic acid fillers in the face. In both cases, skin discoloration and pain was observed. In one case, the complication was immediately recognized and treated with 300IE hyaluronidase. In the other case, the complication was not recognized promptly and treated only five days after the injection. She presented to us with advanced pustule formation and incipient necrosis. Both patients could be successfully treated by repeated targeted ultrasound-guided hyaluronidase administration without loss of tissue or function and an immediate reduction in pain.
Conclusion
Targeted Ultrasound-guided Hyaluronidase injection represents an effective method to immediately reduce the pain and treat the complications of HA Injections in a tissue-sparing manner. It is a safe and economic tool to quickly restoring bloodstream and safe vital tissue.

Ultrasound-guided Hyaluronidase Injection for vascular occlusion after Hyaluronic acid Filler Injection, Two Case reports

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