Indocyanine Green Angiography for Objective Perfusion Monitoring After Hyaluronic Acid Filler‐Induced Facial Vascular Occlusion
Guangdi Li, Guiwen Zhou, Miao Wang, Hongfan Ding, Chongli Yu, Qiang Fu, Minliang ChenABSTRACT
Background
Hyaluronic acid (HA) filler‐induced facial vascular occlusion may cause cutaneous ischemia, necrosis, and disfigurement. Clinical assessment and imaging‐guided hyaluronidase‐based intervention remain central, but vessel‐level localization does not directly quantify downstream tissue perfusion after rescue treatment.
Objectives
To evaluate indocyanine green angiography (ICGA) as an adjunctive tissue‐level tool for monitoring perfusion changes after initial rescue treatment.
Materials and Methods
This exploratory single‐center retrospective feasibility study included patients with clinically diagnosed HA filler‐induced facial vascular occlusion who underwent paired ICGA before and after initial rescue treatment between July 2025 and March 2026. ICGA‐derived parameters included ingress rate, time to peak (TPP), and curve ingress. Curve ingress percent change was calculated as the change in curve ingress divided by baseline curve ingress.
Results
Twenty‐six patients were included. After initial rescue treatment, median ingress rate increased from 12.50 to 16.20, with a median change of 4.85 (IQR, 3.00–8.57; p < 0.001). Median TPP shortened from 31.46 to 23.87 s, with a median change of −6.09 s (IQR, −11.69 to −3.93; p < 0.001). Median curve ingress increased from 63515.95 to 77862.55, with a median change of 14432.45 (IQR, 9891.28–20269.65; p < 0.001). The two patients requiring treatment escalation showed the lowest percent changes in curve ingress.
Conclusions
ICGA demonstrated early tissue‐level perfusion changes after initial rescue treatment. Limited early curve ingress improvement may support closer surveillance or timely escalation when interpreted with clinical findings.
Trial Registration
ClinicalTrials.gov, NCT07581652