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Physician to Physician Discussions > Dermal Filler Skin Ischaemia

Hi..I was wondering if someone can advise:
Performed cheek fillers on patient 1 month ago. 1.0 ml perlane per side (cross hatched over an area of 2x2 cm). Patient developed a 1cm circular scab on one cheek which eventually fell off. Now the skin in that region is pink due to erythema....its been a month and not really getting better. Can someone advise something topically to put on that might help.

01.25 | Unregistered CommenterDrNed


Can you send me a picture of it? Are you sure it is from vascular occlusion? Send it to

Lornell E. Hansen II, M.D.

01.25 | Unregistered CommenterLH

You should call your Restylane rep and ask for a vial of hyaluronidase to break down the perlane. Aggresive Cross hatching in the cheek area may injur vessels and nerve. Considering the procedure was done in a sterile environment, the risk of infection is rare. The erythematous scab maybe due to poor circulation to particular area of tissue due to vessel occlusion (hematoma or perlane). Either way the problem will resolve in a few more months. If you are not able to get your hands on hyaluronidase, try using the Sciton ST skin tyte to heat the area to promote break down of perlane particles and enhance circulation. Remember that all reactions are accelerated by simply adding heat.

When I instruct physicians new to filler procedures. I teach them to start with simple threading. cross hatching is an advanced technique. The result is better than threading. However risk of vessel damage / nerve damage should be considered in certain areas.

Mr. Wang, are you saying what I have observed already that heat does in fact compromise the integrity of HA fillers by breaking them down so they are metabolized by the body faster?

02.4 | Unregistered CommenterMISSG

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