Delayed vascular occlusion following hyaluronic acid-based skin booster – A rare case report

Abstract

Hyaluronic acid (HA) based skin boosters used for treating fine lines and for enhancing the quality of skin are quite popular as they help by drawing water under the dermis (hydrofilling effect), helping in prolonged hydration of the skin. They are also considered safe due to the superficial plane of injection and low volumes injected. The patient came to the clinic for skin hydration and rejuvenation treatment. After detailed discussion and informed consent, a non-animal origin HA-based skin booster with a concentration of 20 mg/mL was chosen for facial rejuvenation. As per protocol, 2 mL of the product was injected by micropuncture technique with the automated click technology, delivering 0.01 mL per point in the mid dermis all over the cheeks, chin, and forehead. The patient tolerated the procedure well and presented to us 48 hours post-injection with persisting redness and pain on the central forehead. The redness appeared to be in a triangular pattern, with the apex at the left eyebrow and the base toward the hairline. Diagnosis of vascular compromise was made, and the patient was immediately treated with pulsed doses of hyaluronidase. The entire area healed without any sequelae. We hereby report a rare case of delayed vascular occlusion following skin booster treatment, which was successfully managed by hyaluronidase treatment. Skin boosters are the most sought after treatments for skin hydration and are generally considered safe; this is the first case report with delayed vascular occlusion reported following skin booster injections. Because of the high risk associated with glabella and forehead areas for fillers, one should be mindful in this area even with the skin boosters.