What it is

→ Vascular occlusion protocol refers to the structured emergency management plan followed when dermal filler injections accidentally block a blood vessel.

→ Vascular occlusion occurs when filler material obstructs arterial or venous blood flow, leading to skin blanching, severe pain, and potential tissue necrosis.

→ Though rare, it is considered one of the most serious complications of injectable aesthetic procedures.

→ A vascular occlusion protocol ensures rapid recognition, immediate intervention, and proper follow-up, preventing permanent damage such as skin loss, scarring, or blindness (if near the eyes).

Why it’s done

→ The protocol is performed to:

• Save tissue by restoring blood circulation quickly.
• Prevent necrosis (death of skin tissue).
• Avoid permanent scarring or deformities.
• Protect vision in cases where occlusion occurs near the eye region.
• Provide patient safety and reassurance in cosmetic procedures.

→ Without a clear protocol, delays in treatment can result in severe medical and cosmetic consequences.

Alternatives

→ There is no true alternative to vascular occlusion protocol when an occlusion occurs. It is a medical emergency that requires immediate professional intervention.

→ Preventive strategies include:

• Using cannulas instead of sharp needles in high-risk zones.
• Injecting slowly with minimal pressure.
• Aspirating before injection to check for intravascular placement.
• Knowledge of vascular anatomy to avoid risky areas.

→ However, once occlusion happens, the only option is to follow the emergency protocol immediately.

Preparation

→ Clinics must be prepared with:

• Emergency kits containing high-dose hyaluronidase (for dissolving HA fillers).
• Sterile saline for flushing.
• Aspirin tablets to reduce clot formation.
• Topical nitroglycerin paste to dilate blood vessels.
• Warm compresses to increase circulation.
• LED or hyperbaric oxygen therapy access for severe cases.
• Emergency referral contacts (ophthalmology, hospital care).

→ Practitioners and staff should be trained regularly to recognize early signs and act immediately.

How it’s Done

→ A vascular occlusion protocol involves step-by-step intervention:

1. Immediate recognition
   • Look for sudden pain, blanching of the skin, dusky discoloration, or mottling.
2. Stop injection immediately
   • Do not continue injecting filler in the area.
3. Massage and heat
   • Apply warm compresses and massage the area to improve blood flow.
4. Hyaluronidase injection
   • Administer high-dose hyaluronidase (150–300 units or more, depending on severity) directly into and around the affected area.
   • Repeat every 30–60 minutes as needed until reperfusion occurs.
5. Adjunctive measures
   • Apply nitroglycerin paste to dilate vessels.
   • Give aspirin (oral, usually 300–325 mg) to reduce platelet aggregation.
   • Consider low molecular weight heparin in severe cases (under physician guidance).
6. Supportive therapy
   • Oxygen supplementation.
   • Hyperbaric oxygen therapy if available, for stubborn or severe cases.
   • Antibiotics if tissue necrosis develops.
7. Ophthalmic emergency (if vision is affected)
   • Immediate referral to an ophthalmologist for intra-arterial hyaluronidase, retrobulbar injections, or advanced care.
8. Follow-up
   • Daily monitoring for skin healing.
   • Scar management, if needed, with laser, microneedling, or PRP.

→ The first 90 minutes are critical; rapid action can mean the difference between full recovery and permanent damage.

Recovery

→ Recovery depends on the severity of the occlusion and how fast treatment was initiated:

• Early intervention → most patients recover fully within days to weeks.
• Delayed intervention → may result in partial necrosis requiring wound care, scar prevention, or reconstructive procedures.
• Ocular occlusions → prognosis varies; immediate ophthalmologic care is vital to preserve vision.

→ Long-term recovery may include:

• Scar management → silicone sheets, steroid injections, or laser therapy.
• Pigmentation correction → if skin discoloration remains.
• Psychological support → reassurance and counseling for patients after complications.

Complications

→ Even with prompt care, possible complications include:

• Skin necrosis → if circulation is not restored quickly.
• Scarring or fibrosis.
• Pigment changes (post-inflammatory hyperpigmentation or hypopigmentation).
• Chronic pain or sensitivity in the affected area.
• Vision loss if occlusion affects the retinal artery and is not treated immediately.

→ These risks highlight why vascular occlusion protocols must be standardized in all injection clinics.

Treatment options in Korea

→ Korea is globally recognized for aesthetic injection safety protocols, including advanced vascular occlusion management.

• Emergency readiness → top clinics always stock hyaluronidase, aspirin, nitroglycerin, and sterile kits for rapid response.
• Highly trained injectors → Korean dermatologists and plastic surgeons receive rigorous training in complication management.
• Advanced monitoring → AI-assisted imaging and dermoscopy are sometimes used to track skin reperfusion after occlusion.
• Collaboration with hospitals → strong referral systems to ophthalmology and emergency care for vision-related occlusions.
• Post-recovery programs → clinics provide scar prevention counseling, wound care, and aesthetic correction if needed.
• Medical tourism services → international patients are reassured by Korea’s strong safety culture and emergency preparedness.

→ With Korea’s emphasis on precision, safety training, and comprehensive aftercare, vascular occlusion protocols are considered among the most advanced in the world.