{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:00:43Z","timestamp":1781319643202,"version":"3.54.1"},"reference-count":56,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Significant complications are uncommon with aesthetic hyaluronic acid (HA) dermal fillers, but inadvertent injection of dermal filler into an artery can result in tissue damage, scarring, visual loss, and even stroke. Practitioners must therefore reduce this risk through proactive, preventative techniques. Early recognition of vascular occlusion (VO) is also crucial to minimize subsequent tissue injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To review and summarize evidence\u2010based preventative measures and first aid management strategies for HA\u2010associated peripheral cutaneous VO, explicitly excluding ocular and neurological complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted using the BestBETs methodology to review the preventative measures available for reducing the risks of HA\u2010associated peripheral VO, with ocular and neurological side effects considered beyond this review's scope. We then examined the pathophysiology of VO and the evidence for its management to establish an HA dermal filler VO \u201cfirst aid\u201d protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our review underscored the importance of preventative strategies (practitioner skill and knowledge; cannula usage; microboluses of small filler volumes, low plunger pressure, and constant needle tip movement), along with the liberal usage of hyaluronidase, heat, and massage, and supports the addition of antiplatelet agents for acute management. Aspiration is controversial and cannot reliably exclude intravascular needle placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prompt recognition and management of VO are critical to prevent skin necrosis, scarring, and long\u2010term morbidity. Preventative practice, immediate treatment protocols, and further research are essential to enhance clinician confidence and improve patient safety in aesthetic HA filler procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocd.70884","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T05:14:56Z","timestamp":1778044496000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyaluronic Acid Dermal Filler\u2010Associated Vascular Occlusion\u2014A Review of Prevention and Management Strategies"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4991-7069","authenticated-orcid":false,"given":"Stephen","family":"Lowe","sequence":"first","affiliation":[{"name":"MUSE Clinic  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"G.Campiglio \u201cISAPS International Survey on Aesthetic\/Cosmetic Procedures Performed in 2021 [Internet] \u201d(2021) www.isaps.org."},{"key":"e_1_2_12_3_1","unstructured":"American Society of Plastic Surgeons \u201cPlastic Surgery Statistics Report: ASPS National Clearinghouse of Plastic Surgery Procedural Statistics [Internet] \u201d(2020) www.plasticsurgery.org."},{"key":"e_1_2_12_4_1","first-page":"1047","article-title":"A Randomized, Split\u2010Face, Histomorphologic Study Comparing a Volumetric Calcium Hydroxylapatite and a Hyaluronic Acid\u2010Based Dermal Filler","volume":"13","author":"Yutskovskaya Y.","year":"2014","journal-title":"Journal of Drugs in Dermatology"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.143.2.155"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X13484492"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000354384"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000334"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14295"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjaa086"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/molecules27175398"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000000484"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjw251"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X14525035"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007155"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004287"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010016\u20100630\u20100"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2009.080831"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000001931"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12886\u2010018\u20100768\u20104"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c160006"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/229255030401200307"},{"key":"e_1_2_12_23_1","first-page":"585","volume-title":"Towards Evidence\u2010Based Medicine in Surgical Practice: Best BETs","author":"Khan O. 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