Vascular complications with necrotic lesions following filler injections: Literature systematic review

•Main areas involved in the vascular dermal necrosis followed by filler injection are the nasolabial folds.•Hyaluronidase is the principal mean to treat vascular complication.•In cases of extended lesions, combined protocol can be used. Introduction. Although the related risk of vascular necrosis due to filler injection is low, the outcomes can be severe when they occur. This systematic review aims to report the occurrence and treatment of vascular necrosis due to filler injection. Materials and Methods: The systematic review was performed according to PRISMA guidelines. Results: The results showed the most used treatment is a combination of pharmacologic therapy and hyaluronidase application, which is efficacy when applied in the first 4 h. In addition, even though management recommendations are available in literature, proper guidelines are unavailable due to the low number of complications occurrence. Conclusion:Clinical and high-quality studies on treatment and management of filler injection combination are necessary to provide scientific evidence on what to do in case of vascular complication occurrence.