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Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion

May 1, 2021 No Comments

J Clin Aesthet Dermatol. 2021;14(5):E61–E69. by Gillian Murray, MPharm, PG Dip Clin Pharm, INP; Cormac Convery, MB ChB, MSc, MASLMS; Lee Walker, BDS, MFDS, RCPSG, MJDF, RCS, ENG; and Emma Davies, RN INP Dr. Murray is with Clinical Academic Kings College in London, England. Dr. Convery is with The Ever Clinic in Glasgow, Scotland. Dr. Walker is with B City Clinic in Liverpool, England. Ms. Davies is Clinical Director of Save Face in Cardiff, United Kingdom. All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC). FUNDING: No funding was provided for this article. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. ABSTRACT: Vascular occlusions can occur with injection of dermal fillers causing devastating outcomes for the patient. The occurrence, and subsequent management, of these negative outcomes is a source of significant stress to the aesthetic clinician. Complications management is an essential component of clinical practice and professionals must develop competence and confidence in the identification and effective treatment of a vascular occlusion. The relatively rare occurrence of a vascular occlusion mandates that learning must be largely through the study of theory in addition to the sharing of learning experiences within

Management of a Vascular Occlusion Associated with Cosmetic Injections

January 1, 2020 No Comments

Vascular occlusion has been cited as the most severe and feared early complication in aesthetic treatment1 and the incidence appears to be on the increase.

A Treatment Protocol for Vascular Occlusion from Particulate Soft Tissue Augmentation

May 13, 2012 No Comments

Kenneth Beer, MD; Jeanine Downie, MD; Jacob Beer University of Miami, Miami, Florida Disclosures: Dr. Beer is an investigator for Merz Aesthetics, Medicis, and Allergan and a consultant for Medicis and Allergan. Dr. Beer is a shareholder of Allergan Corporation. Dr. Downie is a consultant and investigator for Merz, Allergan, and Medicis. Abstract Treatment protocols exist for vascular obstruction due to injections with hyaluronic acids. Options for vascular insult due to non-hyaluronic acid products are less defined. The authors report two cases of vascular insult due to calcium hydroxylapatite and discuss treatment options. Patients who have vascular occlusion due to calcium hydroxylapatite require immediate intervention. The authors’ suggested protocol is elucidated and presented as a basis for future discussions and clinical trials. (J Clin Aesthet Dermatol. 2012;5(5):44–47.)

Doppler Ultrasound in the Management of Vascular Complications Associated with Hyaluronic Acid Dermal Fillers

February 1, 2022 No Comments

J Clin Aesthet Dermatol. 2022;15(2):40–43. by; Marco Antonio Munia, MD, PhD; Christine Guarnieri Munia, MD; Meire Brasil Parada, MD; Jose Ben-HurFerraz Parente, MD, PhD and Nelson Wolosker, MD, PhD All authors are with Hospital Moriah in São Paulo, Brazil. FUNDING: No funding was provided for this article. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. Facial injections with hyaluronic acid (HA) dermal fillers have become increasingly common. Hyaluronic acid is currently the most frequently used dermal filler. When compared to collagen for the treatment of nasolabial folds, HA not only produces similar cosmetic results with smaller doses but also lasts longer. Our objective was to evaluate the results of 10 patients with vascular complications associated with HA fillers treated with ultrasound-guided injection of hyaluronidase (HYAL) according to the Brazilian Society of Dermatology guidelines. Admission clinical evaluation revealed that the most frequent signs were: livedo reticularis (100% of the patients), hypoesthesia (50%) and local pain (20%). Although 80% of the patients complained of local pain during HYAL injection, none of them persisted with pain after the procedure ended. The total dose of injected HYAL per patient ranged from 300 to 750 IU (mean 500

Facial Vascular Events and Tissue Ischemia: A Guide to Understanding and Optimizing Wound Care

December 1, 2021 No Comments

J Clin Aesthet Dermatol. 2021;14(12 Suppl 1):S39–S48 by Astra Farmer, RN, NMP; Gillian Murray, MPharm, PG Clin Pharm INP; Brittony Croasdell, NP, ARPN, CANS; Emma Davies, RN, INP; Cormac Convery, MB ChB, MSc; and LEE WALKER, BDS, MFDS, RCS Ms. Farmer is with Devon and Cornwall Aesthetics Academy in Exmouth, England. Ms. Murray is with the Clinical Academic Kings College, London in London, England. Ms. Croasdell is Clinical Director at The Fitz® in Chicago, Illinois, United States. Ms. Davies is Clinical Director of Save Face UK in Bath, England. Dr. Convery is with the Ever Clinic Glasgow in Glasgow, Scotland. Dr. Walker is with B City Clinic in Liverpool, England. All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC). FUNDING: No funding was provided for the preparation of this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ABSTRACT: The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization established to promote best patient outcomes through educating clinicians in the prevention, diagnosis, and management of complications that can arise following nonsurgical cosmetic procedures. The organization is a global community sharing information, learning, experience, and data to promote best

Vascular Complications after Facial Filler Injection: A Literature Review and Meta-analysis

June 1, 2019 No Comments

J Clin Aesthet Dermatol. 2019;12(6):E65–E72 by Giuseppe Sito, MD, PhD; Veronica Manzoni, MD; and Raffaella Sommariva, MD Prof. Sito is with the Prof. Professor Giuseppe Sito Clinic in Turin, Italy. Dr. Manzoni is with the Istituto Auxologico Italiano in Milan, Italy. Dr. Sommariva is a specialist in plastic surgery practicing in Acqui Terme, Italy and Genoa, Italy. ABSTRACT: Background. Vascular occlusion during the injection of facial fillers is uncommon, but can result in serious adverse events, including necrosis, blindness, and stroke. Objectives. We explored factors that influence the frequency and severity of vascular complications during filler injections. Methods. This was a meta-analysis that included case reports and case series published during the years 2004 to 2016 describing patients who experienced any type of vascular complication after an aesthetic procedure. In addition to the descriptive analysis of the variables retrieved, a logistic regression for predicting the outcome of the vascular event was performed. Results: The analysis included 93 cases described in 30 articles. Blindness was the main consequence of the vascular complications (n=57; 61%). The reported outcome was partial or total recovery in 24 cases (28%) and no improvement in 61 cases (72%). Hyaluronic acid (HA) and autologous fat were the two fillers most

Vascular Compromise from Soft Tissue Augmentation

September 23, 2014 No Comments

Experience with 12 Cases and Recommendations for Optimal Outcomes Katie Beleznay, MD, FRCPC, FAAD; Shannon Humphrey, MD, FRCPC, FAAD; Jean D.A. Carruthers, MD, FRCSC, FRC (OPHTH), FASOPRS; Alastair Carruthers, MA, BM, BCh, FRCPC, FRCP (Lon) Drs. Beleznay and Humphrey and Alastair Carruthers are from the Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada. Jean D.A. Carruthers is from the Department of Ophthalmology and Visual Science, University of British Columbia, Vancouver, British Columbia, Canada Disclosure: The authors report no relevant conflicts of interest. Abstract The popularity of soft tissue fillers is, in part, due to their favorable side-effect profile. However, serious complications can occur. The authors describe their extensive clinical experience with soft-tissue augmentation and the rare complication of vascular compromise, which can lead to necrosis and scarring. Over a 10-year period between January 2003 and January 2013, the authors observed a total of 12 cases of vascular compromise. Eight patients in their clinical practice showed evidence of vascular compromise out of a total of 14,355 filler injections (0.05%). In addition, four patients treated with an experimental particulate filler had vascular complications. All cases were examined for filler type, location of complication, risk factors, treatment,

Microinjection Technique: A Novel and Comprehensive Approach for Nose Reshaping with Hyaluronic Acid Fillers

April 29, 2024 No Comments

J Clin Aesthet Dermatol. 2024;17(5):43–47. by Cemre Busra Turk, MD; Bugra Burc Dagtas, MD; Neslihan Fisek Izci, MD; and Gonca Gokdemir, MD Dr. Turk is with the Wellman Center for Photomedicine at Massachusetts General Hospital in Boston, Massachusetts, and Department of Dermatology at Harvard Medical School in Boston, Massachusetts. Dr. Dagtas is with the University of Health Sciences at the Istanbul Training and Research Hospital and Dermatology Clinic in Istanbul, Turkey. Dr. Izci is with the Faculty of Medicine and Department of Dermatology at Bahcesehir University in Istanbul, Turkey. Dr. Gokdemir is with Prof. Dr. Gonca Gokdemir Clinic in Istanbul, Turkey. FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no conflicts of interest relevant to the contents of this article. ABSTRACT: Nose reshaping with hyaluronic acid (HA) fillers, also known as medical rhinoplasty, is an increasingly popular, minimally invasive aesthetic procedure. As the demand for nasal reshaping continues to rise, it is essential to develop safe and efficient injection techniques and assess satisfaction to ensure optimal outcomes and patient-centered care. Objective. This study aims to evaluate patient and physician satisfaction with hyaluronic acid filler applications using microinjection technique for nasal reshaping. Methods. The study included healthy

A Retrospective Review of the Safety and Efficacy of Low-dose Triamcinolone Mixed with Hyaluronic Acid Fillers to Reduce Post-injection Infraorbital Swelling

April 1, 2022 No Comments

J Clin Aesthet Dermatol. 2022;15(4):13–19. by Robyn Siperstein, MD; Jose Raul Montes, MD; and AnnMari Speranza, MS Dr. Siperstein is with the University of Miami in Miami, Florida. Dr. Montes is with the Ophthalmology Department at the University of Puerto Rico in San Juan, Puerto Rico. Dr. Speranza is with the University of Tampa in Tampa, Florida. FUNDING: Funding for editorial assistance was provided by X-Medica, LLC. DISCLOSURES: Dr. Siperstein is a paid consultant, trainer, and recipient of research grants from Allergan & Galderma. Dr. Montes is a speaker and trainer for Allergan/Abbvie, Galderma and MERZ. Ms. Speranza does not have any conflicts to disclose. ABSTRACT: Objective. This retrospective review assesses the efficacy and safety of low-dose triamcinolone (1mg/cc) added to hyaluronic acid fillers to decrease swelling after infraorbital injection. Methods. This retrospective analysis includes 447 patients who underwent 706 infraorbital hyaluronic acid filler treatments from April 2013 to March 2020 by a single injector. Short-term post-procedural swelling (less than or greater to 2 weeks) was assessed through follow-up phone calls, which were documented in patient charts. The effect of triamcinolone, filler type, volume, and patient characteristics on the rate of post-procedure swelling were analyzed. Results. Swelling after infraorbital hyaluronic acid filler

Fluorescence in the Sclera, Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

March 1, 2022 No Comments

J Clin Aesthet Dermatol. 2022;15(3):35–37. by Emel Öztürk Durmaz, MD; and Deniz Demircioglu, MD Drs. Durmaz and Demircioglu are with the Acibadem University School of Medicine in Istanbul, Turkey. FUNDING: No funding was provided for this article DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. ABSTRACT: Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir

Consensus Opinion for The Management of Soft Tissue Filler Induced Vision Loss

December 1, 2021 No Comments

J Clin Aesthet Dermatol. 2021;14(12):E84–E94. by Lee Walker, BDS, MFDS, RCPSG, MJDF, RCS, ENG; Cormac Convery, MB ChB, MSc, MASLMS; Emma Davies, RN, INP; Gillian Murray, MPharm, PG Dip Clin Pharm, INP; and Brittony Croasdell, MS,FNP-BC, APRN CANS Dr. Walker is with B City Clinic in Liverpool, England. Dr. Convery is with The Ever Clinic in Glasgow, Scotland. Ms. Davies is Clinical Director of Save Face in Cardiff, United Kingdom. Ms. Murray is with Clinical Academic Kings College in London, England. All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC). FUNDING: No funding was provided for this article. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. There are multiple treatment strategies proposed for the management of vision loss related to the injection of soft tissue fillers. Currently, there is no internationally accepted consensus on the immediate management of soft tissue filler induced vision loss (STFIVL). A recent systematic review of the literature concluded that there is not enough evidence to support retrobulbar hyaluronidase, and alternative treatments require exploration. The available literature demonstrates the inconsistent and unproven success of retrobulbar and peribulbar hyaluronidase in reversal of soft filler induced

Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol

August 1, 2021 No Comments

J Clin Aesthet Dermatol. 2021;14(8):E69–E75. Download a PDF of this guideline here by Gillian Murray, MPharm, PG Dip Clin Pharm, INP; Cormac Convery, MB ChB, MSc, MASLMS; Lee Walker, BDS, MFDS, RCPSG, MJDF, RCS, ENG; and Emma Davies, RN INP Ms. Murray is with Clinical Academic Kings College in London, England. Dr. Convery is with The Ever Clinic in Glasgow, Scotland. Dr. Walker is with B City Clinic in Liverpool, England. Ms. Davies is Clinical Director of Save Face in Cardiff, United Kingdom. All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC). FUNDING: No funding was provided for this article. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. ABSTRACT: Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for the patient. Hyaluronidase is an enzyme that was first used in general medicine in 1949, but has gained widespread use in aesthetic medicine to dissolve hyaluronic acid (HA)-based dermal fillers. Knowledge of this drug and its use for other aesthetic indications is evolving, and there is often anxiety attached to the administration of animal-derived product due to fears of an allergic reaction.This paper provides guidance on

Guideline for the Management Herpes Simplex 1 and Cosmetic Interventions

June 2, 2021 No Comments

J Clin Aesthet Dermatol. 2021;14(6 Suppl 1):S11–S14 by Devan Vaghela, MBBS, MRCP; Emma Davies, RN, INP; Gillian Murray, MPharm, PG Dip, Clin Pharm, INP; Cormac Convery, MB ChB, MSc, MASLMS; and Lee Walker, BDS, MFDS, RCPSG, MJDF, RCS, ENG Dr. Vaghela is with the Department of Microbiology at Norfolk and Norwich University Hospitals, United Kingdom, and with V&A Aesthetics in London, United Kingdom; Ms. Davies is Clinical Director of Save Face in Cardiff, United Kingdom; Dr. Murray is with Clinical Academic Kings College in London, England; Dr. Convery is with The Ever Clinic in Glasgow, Scotland; and Dr. Walker is with B City Clinic in Liverpool, England. All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC). FUNDING: No funding was provided for the preparation of this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ABSTRACT: The Complications in Medical Aesthetics Collaborative (CMAC) is a not-for-profit organization established to promote best patient outcomes through educating clinicians who perform nonsurgical cosmetic procedures in the prevention, diagnosis, and management of complications that can arise. The organization is a global community sharing information, learning, experience, and data to promote best practice.

Frontoplasty Technique for the Mestizo Patient

March 1, 2021 No Comments

J Clin Aesthet Dermatol. 2021;14(3):14–16. by Shino Bay Aguilera, DO; Mehreen Hall, DO; Dayana Carolina Suárez Carvajal, MD; and Andres Gaviria, MD Dr. Aguilera is with NOVA Southeastern University in Fort Lauderdale, Florida. Dr. Hall is with Larkin Community Hospital Palm Springs Campus in Hialeah, Florida. Dr. Carvajal is with Rosario University in Bogota, Colombia. Dr. Gaviria is with Universidad CES in Medellin, Colombia FUNDING: No funding was provided for this article. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. ABSTRACT: Ethnic groups can be differentiated through certain anatomical characteristics, including the morphological features of their skulls. Little information is available on the craniofacial measures of the Mestizo face. Over time, the upper third of the Mestizo face can develop a greater frontal concavity of the forehead, making the eyebrows drop and giving the face a more masculine appearance. Understanding the skeletal and vascular anatomy of this population group is the foundation for proper aesthetic rejuvenation of the upper third of the face. The purpose of this article is to present an advanced injection technique utilizing a low-viscosity and low-G prime filler to correct exaggerated frontal concavity. Using just 1 to 2mL of

Herpes Zoster as a Differential Diagnosis for Ischemia after Facial Hyaluronic Acid Filler

December 1, 2020 No Comments

J Clin Aesthet Dermatol. 2020;13(12):29–31. by Jessica Shen Tsy Wu Kim, MD; Lilia Ramos dos Santos Guadanhim, MD, PhD; Gisele Jacobino de Barros Nunes, MD; Marco Alexandre Dias da Rocha, PhD; Marco Antonio Munia, MD, PhD; and Samira Yarak, MD, PhD Drs. Kim, Ramos, Jacobino, Dias da Rocha, and Yarak are with the Department of Dermatology at the Federal University of São Paulo in São Paulo, Brazil. Dr. Munia is with the Department of Vascular Surgery at the University of Sao Paulo in São Paulo, Brazil. FUNDING: No funding was provided for this article. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. ABSTRACT: The use of hyaluronic acid (HA) fillers for facial rejuvenation has grown widely and is now one of the most performed noninvasive cosmetic procedures. Viral infections can occur, albeit rarely. This report describes a 65-year-old female patient with significant fat tissue loss in the malar region who developed herpes zoster after receiving HA filler for facial volumization. We performed volumization with a total of 2mL of HA in one session. Two days after the procedure, the patient began feeling mild pain in the malar region bilaterally and in the right

January 2020 Editorial Message

January 1, 2020 No Comments

Vol. 13, No. 1 • January 2020 Dear Colleagues: Welcome to the January 2020 issue of The Journal of Clinical and Aesthetic Dermatology (JCAD). We begin the issue with a review titled, “Rethinking the Journal Impact Factor and Publishing in the Digital Age,” in which Nestor et al define the Journal Impact Factor (JIF) and deconstruct its validity as a modern measure of a journal’s quality. The authors also discuss the current models of academic publication, including their advantages and shortcomings, and discuss a variety of open-access publication models, including those that charge fees to authors. Additionally, the authors review existing alternative methods for measuring journal impact and propose the adoption of a superior publishing model. Next, in a review article by Ahluwalia et al titled, “Incorporating Aesthetic Devices into a Dermatologic Practice,” the authors review the benefits and drawbacks of purchasing or leasing energy-based devices, highlighting key factors to consider when incorporating these devices into a practice, such as cost, training, and level of use. After this, in an original research article by Borges et al titled, “Fractional Laser Resurfacing Treats Photoaging by Promoting Neocollegenesis and Cutaneous Edema,” the investigators compared the effects of nonablative and ablative Erbium fractional

Prolonged Periorbicular Edema After Injection of Hyaluronic Acid for Nasojugal Groove Correction

September 1, 2019 No Comments

by Ricardo Augusto Sandoval Vasquez, MD; Kelly Park, MD, MSL; Katherine Braunlich, DO; Shino Bay Aguilera, DO Dr. Vasquez is with the Department of Esthetic Medicine at Rosario University in Bogota, Colombia. Dr. Park is with the Section of Dermatology in the Medicine Service Line at Edward Hines Jr. VA Hospital in Hines, Illinois. Dr. Braunlich is with the Department of Dermatology at Largo Medical Center in Largo, Florida. Dr. Bay is with Shino Bay Cosmetic Dermatology & Laser Institute in Fort Lauderdale, Florida and the Department of Dermatology at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Florida. ABSTRACT: The injection of hyaluronic acid (HA), a naturally occurring biopolymer, is a common cosmetic procedure. Despite their efficacy and growing adaptation by the medical community, HA fillers occasionally give rise to adverse events. Adverse events from HA fillers range from temporary, such as edema and erythema, to more long-term effects, including granulomas or, in rare cases, sequelae from vascular occlusion. Here, we present a case of a 61-year-old Caucasian woman with prolonged infraorbital hollow edema after injection of HA filler for nasojugal groove correction. We review the anatomy of the nasojugal area and differing injection techniques as a possible

Self Injection of Topical Skin Preparation by Patient Seeking Facial Volume Enhancement: A Case Report

August 1, 2019 No Comments

by David S. Martin, MD, FACS; HaoWei Han, MS; and Kimberly L. Farley, MSN, FNP-BC Dr. Martin and Ms. Farley are with Middle Tennessee Plastic Surgery in Murfreesboro, Tennessee. Mr. Han is with the Debusk School of Osteopathic Medicine, Lincoln Memorial University in Harrogate, Tennessee. FUNDING: No funding was provided for this study. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ABSTRACT: A 25-year-old man seeking increased prominence of the cheeks self-injected a topical skin preparation containing hyaluronic acid into his malar soft tissues. Labeling and marketing of the product, which highlighted the hyaluronic acid as one of the ingredients, might have contributed to his misunderstanding of the intended use for the product. Additionally, a popular medical-based talk show and numerous videos online contributed to the errant belief that self-administration was a viable option. Complications from the injection of nonpharmaceutical substances of this type and implications for treatment in clinical practice are discussed. KEYWORDS: Dermal fillers, complications, cosmetics, hyaluronic acid, hyaluronidase, nonmedical, self-injection, soft tissue augmentation, sunscreens, unlicensed J Clin Aesthet Dermatol. 2019;12(8):51–54 Popularity of injectable dermal fillers has grown enormously in recent years, because they offer a cosmetic improvement without surgery and are

June 2019 Editorial Message

June 1, 2019 No Comments

VOL. 12, NO. 6 • JUNE 2019 Dear Colleagues: Welcome to the June 2019 issue of The Journal of Clinical and Aesthetic Dermatology (JCAD). In this issue, we are pleased to present the article “Update on the Management of Rosacea from the American Acne & Rosacea Society (AARS),” by Del Rosso, Tanghetti, Webster, Stein Gold, Thiboutot, and Gallo. This article updates the previously published consensus recommendations from the AARS on the management of rosacea, including discussions of available published data on topical ivermectin, topical oxymetazoline, combination therapy approaches, and physical therapeutic devices for the management of rosacea. Consistent with what many publications on rosacea currently emphasize, the authors encourage clinicians to define the clinical manifestations of rosacea in the patient at presentation and to “select therapies that correlate with the optimal treatment of those manifestations.” Next, Vasicek et al present the results of their survey analysis in the article titled, “” Here, the investigators sought to quantify the estimated frequency of coprescription of isotretinoin and systemic corticosteroids in acne and assess trends as they relate to age, sex, race, insurance, and provider specialty. The results indicate that coprescription of isotretinoin and systemic corticosteroids is very rare, and the authors postulate

This Month’s Guideline: Management of Necrosis

July 1, 2018 No Comments

J Clin Aesthet Dermatol. 2018 Jul; 11(7): E53–E57. By Martyn King, MD Welcome to the JCAD Aesthetic Complications Guidelines by The Aesthetic Complications Expert (ACE) Group. The ACE Group developed a series of evidence-based, peer-reviewed guidelines that cover complications that can occur in nonsurgical aesthetic practices. The objective of this series is to help dermatologists and other physicians performing aesthetic procedures identify and manage these potential complications. Each guideline was produced after a vast literature review by leading experts in the United Kingdom. We hope these guidelines help raise treatment standards within the medical community and ensure early diagnosis and appropriate management of complications, ultimately improving outcomes for our patients. BACKGROUND Necrosis is defined as “the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.”1 Unlike normal cell death, which is a programmed and ordered phenomenon, necrosis is the accidental death of the cell, which can be caused by various mechanisms, such as an insufficient supply of oxygen, thermal or mechanical trauma, or irradiation. Cells that are undergoing necrosis swell and then burst (cytolysis), releasing their contents into the surrounding area. This results in a locally triggered inflammatory

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