Evidence map›Paper›PMID 40770496›Full record

SynthesisAesthetic plastic surgery2026

Guide for Managing Vascular Occlusion Caused by Fillers with Exclusive Cutaneous Involvement: A Review of Diagnosis, Classification, and Treatment.

Javier Madero-Pérez, Marta Gil-Martinez, Cristina Muñoz-Gonzalez, Daniella Fakih, Paula Martin-Marfil, Nabil Fakih-Gomez

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Review
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Javier Madero-PérezDepartment of Medicine, Universitat Jaume I, Castellón, Spain.
Marta Gil-MartinezPrivate Practice, Castellon, Spain.
Cristina Muñoz-GonzalezDepartment of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran Main Street, Khaizaran, 00000, Lebanon.
Daniella FakihDepartment of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran Main Street, Khaizaran, 00000, Lebanon.
Paula Martin-MarfilDepartment of Endocrinology and Medical Nutrition, Salamanca, Spain.
Nabil Fakih-GomezDepartment of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran Main Street, Khaizaran, 00000, Lebanon. info@drnabilfakih.com.ORCID 0000-0003-4464-8258

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPrompt management of vascular occlusion from hyaluronic acid (HA) fillers is crucial to prevent permanent tissue damage. This study reviews key factors influencing clinical outcomes-excluding ocular cases-and evaluates current protocols and modern treatment strategies

methodsA systematic literature review was conducted to develop an action guide for managing vascular occlusion, focusing on both technical and pharmacological aspects. The search prioritized publications with significant clinical impact and expert guidelines, excluding older studies to ensure alignment with modern angiosome concepts and recent advancements in interventional radiology. The review, conducted using PubMed, identified 96 relevant articles. Keywords included "Dermal Fillers", "Vascular Occlusion", and "Complications".

resultsPain and skin color changes are the most prevalent signs of vascular occlusion. Immediate intervention within the first 4-6 h significantly improves prognosis, with early-stage ischemia being reversible in up to 80% of cases. A structured classification system, incorporating the FOEM2 score and ischemic staging, enables precise treatment decisions. High-dose HYAL (1500 IU), administered every 15-20 min, remains the primary treatment, with ultrasound guidance reducing required doses by up to tenfold. Antiplatelet therapy mitigates HA-induced platelet aggregation. Corticosteroids control the inflammatory response, while vasodilators are reserved for post-resolution perfusion improvement. Hyperbaric oxygen therapy enhances tissue oxygenation, supporting ischemic recovery.

conclusionAccurate and timely diagnosis, along with prompt intervention using protocols based on current angiosome concepts and advanced techniques, is crucial for managing vascular occlusions. Establishing standardized guidelines will enhance patient safety and treatment efficacy in aesthetic medicine. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Indexed as

Cosmetic TechniquesDermal FillersHyaluronic AcidHumansPractice Guidelines as TopicRisk AssessmentTreatment OutcomeDermal FillersHyaluronic AcidDermal fillersHyaluronidaseIschemia managementVascular occlusion

Identifiers

PMID40770496

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.