{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:50:49Z","timestamp":1782370249675,"version":"3.54.5"},"reference-count":16,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Hyaluronic acid fillers are currently the most widely used materials in aesthetic medicine and represent one of the most frequently performed minimally invasive procedures worldwide. Vascular occlusion is the most severe complication associated with this type if filler injections due to the risk of tissue necrosis and permanent sequelae. Early recognition and precise identification of the affected vascular territory are essential to prevent irreversible damage. Case Presentation: his report describes a case of infraorbital artery occlusion with retrograde extension to the anterior superior alveolar artery and associated gingival ischemia, highlighting the role of high-frequency ultrasound in diagnosis and management. A 60-year-old woman developed vascular occlusion following supraperiosteal HA injection in the medial cheek. Clinical findings included livedo reticularis in the infraorbital and nasal regions, along with ipsilateral gingival anesthesia and mucosal ischemia. High-frequency ultrasound was used to assess the extent and mechanism of vascular involvement. A targeted treatment approach was implemented using low-dose hyaluronidase (100 IU\/mL), with 200 IU administered in the infraorbital region and an additional 100 IU delivered under ultrasound guidance to the affected alveolar branch. Ultrasound examination revealed extrinsic compression of the infraorbital artery and secondary occlusion of the anterior superior alveolar artery consistent with retrograde embolization. Following image-guided administration of hyaluronidase, complete reperfusion was achieved, with resolution of both cutaneous and gingival ischemia and no functional or aesthetic sequelae. Conclusions: High-frequency ultrasound provides critical diagnostic information in vascular complications after HA filler injection, allowing for accurate identification of the mechanism and extent of vascular involvement. Ultrasound-guided low-dose hyaluronidase may represent an effective and safe strategy to restore perfusion while minimizing unnecessary enzyme exposure and associated adverse effects.<\/jats:p>","DOI":"10.3390\/diagnostics16131973","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:16Z","timestamp":1782366496000},"page":"1973","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-Guided Low-Dose Hyaluronidase for Infraorbital Artery Occlusion with Secondary Gingival Ischemia After Hyaluronic Acid Filler Injection: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"given":"Carla","family":"Barber-Garc\u00eda","sequence":"first","affiliation":[{"name":"Cl\u00ednicas Carla Barber, 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3932-231X","authenticated-orcid":false,"given":"Endika","family":"Nevado-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Endika Nevado Cirug\u00eda Pl\u2019stica y Est\u00e9tica, 09004 Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"N\u00fa\u00f1ez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Universidad Isabel I, 09001 Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejo","family":"Cavadas","sequence":"additional","affiliation":[{"name":"Cl\u00ednicas Carla Barber, 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Bueno-de la Fuente","sequence":"additional","affiliation":[{"name":"Santa Clara Health Center, 09002 Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-9060","authenticated-orcid":false,"given":"Jer\u00f3nimo Javier","family":"Gonz\u00e1lez-Bernal","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Burgos, 09001 Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1097\/01.prs.0000204759.76865.39","article-title":"Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane)","volume":"117","author":"Matarasso","year":"2006","journal-title":"Plast. 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Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3971","DOI":"10.1007\/s00266-024-04334-1","article-title":"Conventional High-Dose vs. Low-Dose Hyaluronidase for Skin Necrosis after Hyaluronic Acid Fillers: A Systematic Review and Pilot Meta-Analysis","volume":"48","author":"Boey","year":"2024","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e5765","DOI":"10.1097\/GOX.0000000000005765","article-title":"The Posthyaluronidase Syndrome: Dosing Strategies for Hyaluronidase in the Dissolving of Facial Filler and Independent Predictors of Poor Outcomes","volume":"12","author":"Wilde","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.2466\/pr0.1980.46.3.1006","article-title":"On Age and Machiavellianism","volume":"46","author":"Murray","year":"1980","journal-title":"Psychol. Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/1973\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:36:44Z","timestamp":1782369404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/13\/1973"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":16,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16131973"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16131973","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}