I'm worried that I have a vascular occlusion from Restylane. I noticed a bluish area. What can be done?

Hi Kristinaya. This looks like it was several days ago, so hopefully you have had a chance to see your injector. If the redness is not associated with your home care, then there is some concern.  The bluish appearance could simply be bruising, but as one practitioner pointed out, the extended areas of redness could indicate something more serious.  Usually pain does accompany a vascular occlusion, but just because you are not experiencing any does not mean a problem isn't present.  As others have stated, Vitrase (Hyaluronidase), warm compresses, message and nitro paste are all options for limiting any adverse effects if there is an occlusion.  Hopefully you were able to see your injector and get everything worked out.  Best of luck.

Dear kristinaya,I agree with the other doctors and you should be seen immediately for dissolvingThis will likely take some post op care to help the skin heal the bestI hope all goes well with you and this resolves sooner than laterBest regards,Dr. Nima
Member, American Academy of Facial Plastic and Reconstructive Surgery
Board Certified Facial Plastic Surgeon
Board Certified in Head and Neck Surgery

This is for sure occlusion via pressure or blockage and needs immediate care.  Hyperbaric oxygen, hyaluronidase, nitropaste, oral aspirin, laser genesis. I suggest seeing an expert.  Best, Dr. Emer.

In looking at the photograph of the cheek, it does not have the motled pattern or dusky look typically associated with tissue ischemia. Nevertheless, this would be a cheek I personally would flood with enzyme. The downside risk of this is low.  If the cheek color immediately perks up, then that would be consistent with ischemia or partial ischemia. I would recommend doin this immediately it these changes are still present. I would recommend using 600 to 1200 until of hyaluronidase.  Call your injector now and have this done.

Thank you for your question! In looking at the photograph of the cheek, it does not have the motled pattern or dusky look typically associated with tissue ischemia. Nevertheless, this would be a cheek I personally would flood with enzyme. The downside risk of this is low.  If the cheek color immediately perks up, then that would be consistent with ischemia or partial ischemia. I would recommend doin this immediately it these changes are still present. I would recommend using 600 to 1200 until of hyaluronidase. Best of luck!

I would probably say this is vascular occlusion. When redness occurs well beyond the area of injection, it is concerning. It might be related to your heat compresses but at the very least it needs immediate evaluation by your physician. Livedo reticularis is a sign of vascular occlusion but doesn't always occur early. It is a web-like blue vessel pattern. If it is concluded as being vascular occlusion, it needs high doses of hyaluronidase, often repeated. Heat, aspirin, massage all need to be done as well. Nitroglycerin paste is controversial and can lower blood pressure. If there is continued necrosis/ischemia after maximizing the above measures, hyperbaric oxygen therapy is indicated to supply oxygen to the poorly perfused tissue. To minimize risk of this complication, large bore cannulas are always used in my patients and constant movement. Vein injections won't lead to vascular occlusion, only intra-arterial injections.

Hello!
Thank you for your question and for providing pictures. I would definitely head over to the person that injected you so that you can get the product dissolved with hyaluronidase. Continue with warm compression and take a baby aspirin if possible. Please act quickly as necrosis can occur if left untreated.
Best of Luck!
Glow Med Spa Encino

See your injector ASAP, a intravenous/ intrarterial injection can lead to skin necrosis. Hyaluronidase, nitric paste, and massage may help.Best. Dr Brecht