Background Inadvertent intra‐arterial injection of dermal fillers including calcium hydroxylapatite (CaHA) can result in serious adverse events including soft tissue necrosis, permanent scarring, visual impairment, and blindness. When intra‐arterial injection occurs, immediate action is required for optimal outcomes, but the infrequency of this event means that many physicians may never have experienced this scenario. The aim of this document is to provide evidence‐based and expert opinion recommendations for the recognition and management of vascular compromise following inadvertent injection of CaHA. Methods An international group of experts with experience in injection of CaHA and management of vascular complications was convened to develop a consensus on the optimal management of vascular compromise following intra‐arterial CaHA injection. The consensus members were asked to provide preventative advice for the avoidance of intravascular injection and to produce a treatment protocol for acute and delayed presentation. To ensure all relevant treatment options were included, the recommendations were supplemented with a PubMed search of the literature. Results For prevention of intra‐arterial CaHA injection, consensus members outlined the importance of a thorough knowledge of facial vascular anatomy and patient history, as well as highlighting potential risk zones and optimal injection techniques. Individual sections document how to recognize the symptoms of vascular occlusion leading to vision loss and tissue necrosis as well as detailed treatment protocols for the management of these events. For impending tissue necrosis, recommendations are provided for early and delayed presentations with treatment protocols for acute and follow‐up treatment. A separate section details the treatment options for open and closed wounds. Conclusions All physicians should be prepared for the eventuality of intra‐arterial injection of a dermal filler, despite its rarity. These consensus recommendations combine advice from aesthetic experts with the latest reports from the published literature to provide an up‐to‐date office‐based protocol for the prevention and treatment of complications arising from intra‐arterial CaHA injection.

dministration of neuromodulators (independent of the brand used) continues to increase in popularity. According to the annually released plastic surgery statistics report by the American Society of Plastic Surgeons, 7,697,798 botulinum toxin type A injection procedures were performed in 2019, which represents an increase by 4 percent to 2018 and an increase by 878 percent when compared to 2000.

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Dermal fillers for soft tissue augmentation have become increasingly popular among patients of all ages and ethnicities. With more widespread use, there has been an increased incidence of adverse reactions, one of which is the granulomatous foreign body reaction (GFBR). This is a relatively rare, but significant complication of dermal filler use, as it presents both aesthetic and medical implications such

L-lactic acid (PLLA) is a synthetic biologic polymer that is suspended in solution and can be injected for soft-tissue augmentation. The most common adverse events generally are transient in nature, such as swelling, tenderness, pain, bruising, and bleeding. Persistent adverse events of PLLA primarily are papule and nodule formation. Injecting PLLA into the anterior neck is an off-label procedure and may cause a higher incidence of nodule formation.

Managing patient expectations can be a difficult task and is one that cosmetic dermatologists frequently encounter. Misinformation and unrealistic expectations can oftentimes exist regarding cosmetic procedures and their results. These misconceptions can result in patient dissatisfaction and frustration on the physician's behalf. This case report underscores the importance of utilizing what is arguably the most basic and ancient tool in the office, the mirror. There are many different facets to the patient encounter and a variety of devices at the physician's disposal. Proper use of this valuable tool can improve communication, elucidate patient concerns, and reflect the focus on the patient. These can ultimately lead to improved procedure outcome and patient satisfaction.

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