摘要

Objectives: To present a real clinical case of vascular occlusion with skin necrosis following hyaluronic acid filler injection. To demonstrate a practical, step-by-step protocol for managing this severe complication. To provide insights into long-term recovery and skin regeneration after ischemic injury. Introduction: Vascular occlusion is one of the most feared complications in dermal filler therapy due to the risk of irreversible tissue necrosis. Despite its rarity, every injector must be prepared to recognize and act quickly. This presentation highlights a real-world case of delayed patient referral with frontal necrosis and details the successful resolution protocol applied in a clinical setting. Materials / method: This case-based presentation outlines the management of a patient who presented on day 29 after hyaluronic acid injection in a high-risk area. Treatment included enzymatic therapy, systemic and topical wound care, and regenerative support. Clinical photos documented every stage of healing, and recovery was evaluated over several months. Results: Despite the late intervention, full restoration of the skin flap, vascularization, and nerve function was achieved. The patient experienced progressive healing with no permanent scarring or structural deformation. This case confirms that even delayed necrosis can be successfully managed with a structured, regenerative protocol. Conclusion: Timely recognition is key, but structured intervention can yield positive outcomes even in late-stage complications. This case highlights the importance of protocolized aftercare and supports the role of aesthetic physicians in managing complex adverse events with a combination of medical and regenerative strategies.