Advanced Regenerative Drainage and Immunomodulatory Protocol for Dermal Filler-Induced Skin Necrosis: A Prospective Clinical Case Series
Abstract
Background: The widespread use of hyaluronic acid (HA) dermal fillers has been accompanied by an increase in vascular complications, including ischemia and cutaneous necrosis. Although uncommon, filler-induced vascular compromise represents one of the most severe adverse events in aesthetic medicine and requires immediate recognition and intervention. Conventional management strategies based primarily on hyaluronidase may be insufficient in advanced ischemic stages, where inflammatory amplification and microvascular dysfunction contribute to progressive tissue injury.
Objective: To evaluate the clinical outcomes of the Advanced Regenerative and Immunomodulatory Drainage Protocol (ARDIP), a multimodal therapeutic approach designed to restore tissue perfusion, reduce inflammatory burden, and promote regenerative healing in patients with facial skin necrosis secondary to hyaluronic acid dermal fillers.
Methods: A prospective, non-randomized interventional case series was conducted including 20 patients presenting with vascular occlusion (VO) and cutaneous necrosis following hyaluronic acid injections. Lesions were classified according to a staged ischemic progression system (VO Stages III-Vb). All patients were treated using the ARDIP, which integrates high-dose hyaluronidase reperfusion, topical fibrinolytic therapy, controlled mechanical drainage through micropuncture techniques, and stage-adjusted systemic and regenerative adjuvant therapies. Clinical outcomes were assessed…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 20 participants or records.
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