{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:02:56Z","timestamp":1792785776257,"version":"4.5.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":272,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sinclair Pharma Ltd","id":[{"id":"https:\/\/ror.org\/00ab7gt92","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vascular occlusion (VO) is a rare but serious complication of dermal filler injection. Current management protocols are derived primarily from hyaluronic acid fillers and rely on enzymatic degradation with hyaluronidase. Ellans\u00e9 (PCL-CMC) is a poly-\u03b5-caprolactone (PCL)-based filler composed of PCL microspheres suspended in a carboxymethyl cellulose (CMC) gel carrier, neither of which is a substrate for hyaluronidase; a product-specific management approach is therefore required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop expert consensus recommendations for the recognition and management of VO associated with PCL-CMC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A targeted literature review (PubMed, January 2009\u2013August 2025), in vitro rheometry and flow testing, and a three-round modified Delphi consensus process involving seven international experts were used to develop a staged management algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At 1:5 dilution, PCL-CMC viscosity decreased approximately 80-fold to near-aqueous levels; hyaluronidase solution conferred no additional benefit over saline alone. A full consensus or a consensus based on majority of the experts consensus (\u226580%) was achieved on the majority of statements, including CMC-mediated obstruction as the primary mechanism, high-volume saline flushing with mechanical dispersion as first-line therapy, and retention of hyaluronidase in a supportive role.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This consensus-derived algorithm prioritizes reperfusion through dilution and mechanical dispersion rather than enzymatic degradation. Prospective clinical validation is required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 5 (Therapeutic)<\/jats:title>\n                    <jats:p>For image description, please refer to the figure legend and surrounding text.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/asjof\/ojag167","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:25:58Z","timestamp":1788521158000},"source":"Crossref","is-referenced-by-count":0,"title":["Staged Management of Vascular Occlusion With Ellans\u00e9 (Polycaprolactone): A Modified Delphi Expert Consensus"],"prefix":"10.1093","volume":"8","author":[{"given":"Francisco","family":"de Melo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Li","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Vercesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Aribi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Santaella-Sosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filis","family":"Demirgean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdelrahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryaan","family":"Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariyah","family":"Yazdani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093009435071500_ojag167-B1","author":"International Society of Aesthetic Plastic Surgery"},{"key":"2026093009435071500_ojag167-B2","first-page":"E61","article-title":"Guideline for the management of hyaluronic acid filler-induced vascular occlusion","volume":"14","author":"Murray","year":"2021","journal-title":"J Clin Aesthetic Dermatol"},{"key":"2026093009435071500_ojag167-B3","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14141555","article-title":"Adverse effects associated with dermal filler treatments: Part II Vascular complication","volume":"14","author":"Hong","year":"2024","journal-title":"Diagnostics"},{"key":"2026093009435071500_ojag167-B4","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-54202-w","article-title":"Disastrous cerebral and ocular vascular complications after cosmetic facial filler injections: a retrospective case series study","volume":"14","author":"Zhao","year":"2024","journal-title":"Sci Rep"},{"key":"2026093009435071500_ojag167-B5","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1177\/1090820X14525035","article-title":"Complications of injectable fillers, Part 2: Vascular complications","volume":"34","author":"DeLorenzi","year":"2014","journal-title":"Aesthet Surg J"},{"key":"2026093009435071500_ojag167-B6","author":"AQTIS Medical BV"},{"key":"2026093009435071500_ojag167-B7","doi-asserted-by":"publisher","first-page":"2895","DOI":"10.2147\/CCID.S385202","article-title":"Objective assessment of the long-term volumizing action of a polycaprolactone-based filler","volume":"15","author":"Angelo-Khattar","year":"2022","journal-title":"Clin Cosmet Investig Dermatol"},{"key":"2026093009435071500_ojag167-B8","unstructured":"Sinclair Pharma . 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