Indocyanine Green Angiography for Objective Perfusion Monitoring After Hyaluronic Acid Filler-Induced Facial Vascular Occlusion

BACKGROUNDHyaluronic 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.

OBJECTIVESTo evaluate indocyanine green angiography (ICGA) as an adjunctive tissue-level tool for monitoring perfusion changes after initial rescue treatment.

MATERIALS AND METHODSThis 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.

RESULTSTwenty-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.

CONCLUSIONSICGA 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 REGISTRATIONClinicalTrials.gov, NCT07581652

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