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请注明名称（个人，公司，学会等等）: This study was supported by a grant from ZonMw (Dutch Ministry of Health)

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请注明名称（个人，公司，学会等等）: Bsure Medical and I'm a consultant for soft tissue filler adverse events for Abbvie and Galderma

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请注明名称（个人，公司，学会等等）: PROLANIUM / SOFTFIL

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Objectives: To evaluate the efficacy of using the immunosuppressant methotrexate to treat Covid vaccine related delayed onset nodules in twenty-three patients with moderate facial disfigurement unresponsive to established treatment protocols, including intralesional steroids and hyaluronidase.

Introduction: During the COVID-19 pandemic, dermal fillers made world headlines as it was reported that patients who had cosmetic fillers experienced side effects after receiving vaccines that utilised both viral vector and mRNA technology. Initially the Moderna mRNA‐1273 vaccine trial reported an incidence rate of facial swelling of 0.02% after receiving the vaccine, and later similar effects were noted from both the Astra Zeneca and the Pfizer/BioNTech COVID‐19 vaccine. These problems appeared globally and were initially treated with antihistamines, hyaluronidase and intralesional steroids.

Materials / method: Methotrexate is a chemotherapy agent and immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. It is particularly used to reduce activity of the immune system when it mistakenly attacks parts of the body, such as skin and joints, causing illness. Methotrexate is used to treat rheumatoid arthritis, psoriatic arthritis, vasculitis, systemic sclerosis, and severe psoriasis. It initially needs to be closely monitored, requiring blood tests every two weeks until stable, and then every three months.

Results: We identified a cohort of 23 international patients injected with dermal filler or collagen stimulators who presented with delayed onset nodules after receiving the Covid booster vaccine. Eighteen of these patients were from Ireland, three from the United Kingdom, one each from France. the United States and Dubai. All of the patients were unresponsive to established treatment protocols, including antihistamines, 5-fuorouracil (5-FU), 5-FU and lidocaine, and intralesional steroids

Conclusion: All patients successfully responded to 10mgs of Methotrexate for a three-month period and all their nodules dissipated. One patient had to stop the treatment in week ten due to moderately severe anergia. The treatment protocol above was submitted and accepted by peer review at both the AIDA Dermatology Conference in Abu Dhabi (May 2022) and the IMCAS World Conference in Paris (June 2022). It has changed the lives of many patients by reducing the gross distress caused by this condition

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这项工作的完成感谢以下机构的支持： IAPCAM

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Objectives: Present some clinical cases and try to give some more information to answer the question: Is intra-arterial injection using thrombolytic agents and hyaluronidase safe and efficient in H.A filler
induced embolism of ophthalmic and cerebral arteries?

Introduction: With global increase use hyaluronic acid filler, more and more complications. Ophthalmic artery and cerebral artery occlusion are the most severe complications of HA facial injection, of which the later is life threatening. In the literature, total vision recovery from complete blindness is rare.
Recently, some medical centers have proposed intra-arterial injection of thrombolytic agents for ophthalmic artery
occlusion. Yet, if cerebral embolism also occurred, treatment could be complicated.

Materials / method: A prospective study on 6 patients with HA injection induced ophthalmic artery occlusion admitted into Viet Duc Hospital from December 2020 to March 2022. MRIs and CTA were performed if cerebral ischemia was suspected.
Emergency intra-arterial injection using thrombolytic agents and hyaluronidase combined with local and systemic treatments was performed as no contraindication presented

Results: All of the patients were diagnosed with ophthalmic or central retinal artery occlusion via digital subtraction angiography (DSA). Two patients presented with focal neurological signs with frontal lobe infarction on MRI result, altered consciousness, hemiparesis, and seizure. Three patients improved their vision acuity, 2 of which mostly recovered from no light perception (NLP) and light perception (LP), 1 recovered from NLP to LP. Among 3 patients who showed no vision improvement, 1 had a shrinking eyeball which needed prosthetics. Ptosis and ocular motility of all patients improved

Conclusion: HA induced embolism of ophthalmic and cerebral arteries are severe complications. If correctly diagnosed and no contraindication is met, intra-arterial injection using thrombolytic agents and hyaluronidase is a safe and effective method that helps improve vision acuity and reversing cerebral ischemia with minimal risk

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