Resumen

Objectives: To assess the safety and efficacy of fractional CO₂ laser treatment in reducing scarring and improving aesthetic outcomes following HA filler–induced vascular compromise. Introduction: Hyaluronic acid (HA) filler injections are widely used for aesthetic procedures but can be complicated by vascular occlusion, potentially leading to tissue necrosis and permanent scarring. While management of the acute phase is well established, strategies for early scar prevention and treatment in the subacute phase remain limited. Fractional CO₂ laser has been proposed to enhance scar remodeling; however, its safety and efficacy following vascular compromise due to filler injection have not been systematically evaluated. Materials / method: This retrospective study included 25 patients (age range 25–65 years; female:male ratio 3:1) treated at Tel Aviv Sourasky Medical Center after acute management of HA filler–induced vascular occlusion. Patients underwent 2–4 fractional CO₂ laser sessions at 4-6 week intervals. Outcomes were assessed using the Physician Global Aesthetic Improvement Scale (GAIS) at 1 month following the last laser session. Safety was monitored by documenting adverse events. Results: All patients demonstrated improvement in overall appearance, including scar texture and pigmentation. GAIS scores indicated consistent physician-rated aesthetic improvement across the cohort. No major adverse events, including delayed healing or tissue breakdown, were observed. Conclusion: Early initiation of fractional CO₂ laser treatment in the subacute phase after HA filler–induced vascular occlusion appears safe and effective for scar reduction and pigmentation improvement. These findings support the incorporation of laser therapy into post-occlusion care protocols to optimize aesthetic outcomes, although larger controlled studies with longer follow-up are warranted.