Management of vascular complications following calcium hydroxylapatite filler injections:a systemic review of cases and experimental studies

Aim:Dermal fillers are increasingly popular procedures.Inadvertent intraarterial injection of fillers,particularly with calcium hydroxylapatite(CaHA),can result in devastating consequences.A systemic review was performed to summarize management strategies to treat CaHA-associated vascular complications.Methods:The methodology of this review was derived from The Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA).In addition,this paper presents a previously unreported case of a CaHA-associated vascular complication.Results:There were 32 articles describing 42 cases,plus our case included in this review.There were 15 cases of vision complications,23 cases of non-vision complications,and 5 experimental studies.The most common injection sites reported were nasal region for vision complications(45%)and nasolabial folds for non-vision complications(40%).Of the 38 human cases,the most prevalent treatment choice was steroids(24 cases,63%).Complete or near complete improvement was reported in 83%of non-vision complications and 40%of vision complications.There was no noticeable homogeneity in the management strategies and outcomes of the patients.Of the 5 experimental studies,no clear consensus on treatments was found.Conclusion:Vascular complications of CaHA are seemingly uncommon,but it is widely suspected that this is due to underreporting.While best management is prevention,preparation for a potential complication is equally important.Derived from CaHA literature,hyaluronic acid filler complication protocols,findings of this review,and personal experiences,this report proposes management strategies for CaHA-associated vascular complications.We hope these strategies provide a much-needed framework for injectors to refer to and utilize as needed.