Vascular compromise is a rare but serious complication of dermal filler injection.Vessel occlusion tends to have a more immediate onset of symptoms. We report a case of skin necrosis that started with pain, erythema and edema two days after hyaluronic acid filler on the forehead of a 57-year-old woman. The patient was treated with less than 24 hours the onset of symptoms, leaving discreet scar. The current theories that explain skin necrosis caused by HA fillers include angiospasm and embolization. The frontal region has many anastomoses, the embolized proximal vessel initially did not lead to symptoms. However, the HA inside the artery may have traveled over time and reached a terminal distal branch, which generated localized skin damage and pain. The urgent treatment of arterial occlusion and thromboembolism caused by HA injection is intralesional high-dose hyaluronidase. K E Y W O R D Scomplications, hyaluronic acid, skin necrosis | 583 CASSIANO et Al. | C A S E REP ORTA 57-year-old woman with no comorbidities was treated with Restylane Vital® (Galderma) in June 2019 for rejuvenation of the frontal region.The procedure was performed with a 25G cannula, and 0.5 mL of HA was injected into each side in the sub-SMAS plane without complications. At the end of the procedure, the patient was released without complaints and with care instructions. However, two days after the filler injection, the patient developed pain, erythema, and edema in the frontal region. Less than 24 hours after the onset of symptoms, the patient presented with erythema, edema, and pustules in the frontal region ( Figure 1), with the diagnostic hypothesis of vascular obstruction.Hyaluronidase (200 TRU) was injected throughout the treated region, which led to immediate pain relief; the patient was also prescribed 500 mg ASA for 3 days and 40 mg prednisolone for 3 days, which was combined with local heat application. The patient's condition improved and progressed with minimal scarring (Figure 2). How to cite this article: Cassiano D, Miyuki Iida T, LúciaRecio A, Yarak S. Delayed skin necrosis following hyaluronic acid filler injection: A case report. J Cosmet Dermatol.