Management of Polycaprolactone Filler-Induced Ischemia With “THIS and FAT” Protocol: A Case Series

BACKGROUNDPolycaprolactone (PCL)–based fillers demonstrate clinical advantages and favorable aesthetic outcomes. However, due to the nature of their constituents, they present unique and serious challenges, particularly regarding vascular adverse events such as embolism, tissue necrosis, and visual loss.

AIMSThis study presents a case series of five patients with PCL filler–induced vascular complications treated using the “THIS and FAT” protocol. This protocol includes botulinum toxin, high-dose hyaluronidase, injectable platelet-rich fibrin (iPRF), solid platelet-rich fibrin (sPRF), antibiotics and adjunctive medications, nanofat injection, debridement, and nanofat membrane application. The objective was to assess its clinical utility and explore potential therapeutic options in the absence of a definitive reversal agent.

PATIENTS AND RESULTSAll five patients were successfully treated with the “THIS and FAT” protocol, and no major complications were observed. The protocol provides a stepwise therapeutic strategy offering targeted interventions for each stage of ischemia.

CONCLUSIONManaging vascular complications secondary to PCL fillers requires early recognition, rapid implementation of multimodal therapy, and a comprehensive understanding of facial anatomy. In this case series, the “THIS and FAT” protocol guided treatment through a structured, ultrasound-assisted approach that integrates vascular, enzymatic, anti-inflammatory, and regenerative modalities.

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