{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:55:20Z","timestamp":1790816120886,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T00:00:00Z","timestamp":1719878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vascular adverse events (VAEs) occurring during injections of soft\u2010tissue fillers are still considered a challenging issue for both patients and practitioners. Hyaluronidase can dissolve hyaluronic acid (HA)\u2010based soft\u2010tissue fillers during a VAE. For VAEs induced by non\u2010HA fillers, the absence of an \u201cantidote\u201d is regarded as exceptionally challenging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter study describes a case series of three VAEs induced by non\u2010HA fillers, for which ultrasound\u2010guided hyaluronidase injections were incorporated into the treatment approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two cases of calcium hydroxylapatite and one case of poly\u2010L\u2010lactic acid\u2010induced VAEs are described, all of which were resolved without necrosis or scarring using a treatment approach with ultrasound\u2010guided hyaluronidase injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Unlike the mechanical hypothesis, which assumes filler particles travel antegrade to block arterioles in a large skin area, we hypothesize vasoconstriction as the pivot in VAEs. Filler injection\u2010induced spasms could lead to long\u2010lasting vasoconstriction of the perforator arteries stemming from the central facial arteries. Our results underscore that perforasome vasoconstriction might be the leading cause of the ischemia and subsequent necrosis in VAEs and that relaxation of these perforasomes, rather than dissolving the filler material, resolves the clinical symptoms associated with VAEs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.17355","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T01:09:51Z","timestamp":1719968991000},"page":"1252-1255","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Intralesional hyaluronidase injection to relieve non\u2010hyaluronic acid filler\u2010induced vascular adverse events"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5543-5675","authenticated-orcid":false,"given":"Jonathan","family":"Kadouch","sequence":"first","affiliation":[{"name":"ReSculpt Clinic, Practice for Aesthetic Dermatology  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Schelke","sequence":"additional","affiliation":[{"name":"Department of Dermatology Erasmus Medical Centre  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Groh","sequence":"additional","affiliation":[{"name":"Groh Kliniek, Practice for Aesthetic Medicine  Bloemendaal the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Sokol","sequence":"additional","affiliation":[{"name":"Aesthetics by Viktorya, Practice for Aesthetic Medicine  Lincolnshire IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Velthuis","sequence":"additional","affiliation":[{"name":"Department of Dermatology Erasmus Medical Centre  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjac227"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjw251"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.07.032"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(92)90063-4"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004287"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2024.02.008"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000001683"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2021.03.125"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13353"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjaa350"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13127"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181b98a6c"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X15608389"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.17355","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T06:02:03Z","timestamp":1744005723000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.17355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,2]]},"references-count":13,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/ijd.17355"],"URL":"https:\/\/doi.org\/10.1111\/ijd.17355","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,2]]},"assertion":[{"value":"2024-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}