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Correction published on 20 December 2024, see Molecules 2024, 29(24), 6006.
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Review

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

by
Danny J. Soares
1,2
1
American Foundation for Aesthetic Medicine (AFFAM), Fruitland Park, FL 34731, USA
2
College of Medicine, University of Central Florida, Orlando, FL 32827, USA
Molecules 2022, 27(17), 5398; https://doi.org/10.3390/molecules27175398
Submission received: 5 August 2022 / Revised: 19 August 2022 / Accepted: 22 August 2022 / Published: 24 August 2022 / Corrected: 20 December 2024
(This article belongs to the Special Issue Hyaluronan)

Abstract

Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.
Keywords: hyaluronic acid; dermal fillers; hyaluronidase; urokinase; fibrinolytic therapy; skin necrosis; retinal injury; cerebrovascular stroke; pulmonary embolism; angiosome hyaluronic acid; dermal fillers; hyaluronidase; urokinase; fibrinolytic therapy; skin necrosis; retinal injury; cerebrovascular stroke; pulmonary embolism; angiosome

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MDPI and ACS Style

Soares, D.J. Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules 2022, 27, 5398. https://doi.org/10.3390/molecules27175398

AMA Style

Soares DJ. Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules. 2022; 27(17):5398. https://doi.org/10.3390/molecules27175398

Chicago/Turabian Style

Soares, Danny J. 2022. "Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions" Molecules 27, no. 17: 5398. https://doi.org/10.3390/molecules27175398

APA Style

Soares, D. J. (2022). Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules, 27(17), 5398. https://doi.org/10.3390/molecules27175398

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