Aesthetic Complications Experience

Background. Tissue necrosis is one of the most feared early complications of aesthetic injection, arising from interruption of vascular supply, external vessel compression, intravascular embolisation of product, or direct tissue trauma. It has been reported across all filler classes, with the glabellar region and nasal tip/alar triangle recognised as the highest-risk anatomical zones.

Methods. This article is an educational clinical protocol consolidating published evidence rather than a primary study. It reviews recognised incidence figures, cardinal signs and symptoms, high-risk anatomy, and preventive measures, then sets out a stepwise time-critical management algorithm drawn from the existing complications literature and referenced accordingly.

Results. Reported incidence is approximately 9 per 100,000 with collagen fillers (50% glabellar) and around 1 per 100,000 for dermal fillers overall. Severe pain, prolonged reticulated blanching, dusky discolouration and coolness are identified as cardinal warning signs. The protocol specifies immediate cessation of injection, massage, heat, tapping, and, where hyaluronic acid is implicated, high-dose hyaluronidase flooding across the vascular territory, with adjuncts including nitroglycerin paste, aspirin, antibiotics, wound care and escalation to hyperbaric oxygen or plastic surgery.

Conclusion. Prompt recognition of impending necrosis and a time-critical, stepwise management pathway — centred on immediate cessation, vasodilatory measures and, where relevant, aggressive hyaluronidase dosing — are essential to limiting tissue loss. The protocol is intended for clinical education and does not replace clinical judgement, local guidelines or emergency escalation.