A High Likelihood of a Disastrous Outcome: A Case Report of a Complication From the Cosmetic Use of Hyaluronic Acid

Hyaluronic acid (HA) injections are a generally safe procedure, primarily performed to achieve a more aesthetically appealing appearance. Despite the safety of HA filler procedures, complications may arise in some individuals, such as tenderness, lumpiness, swelling, bruising, neurological impairments, embolism, soft-tissue necrosis, irreversible scarring, and baldness. We present a case of a 36-year-old previously healthy female who was injected with HA filler (Juvederm Voluma®) into the nasolabial folds for cosmetic purposes. A few hours later, she reported feeling pain in her right nasolabial region; 27 hours after the injection, the patient presented with a violaceous rash and was diagnosed clinically with arterial compromise due to HA injection 27 hours prior. She was managed with aspirin and hyaluronidase injections into the affected area. The complication resolved after two weeks of follow-up. HA used in our patient was very heavy in its molecular characteristics, and it should not be injected in the nasolabial fold. HA injections can lead to various complications, and both practitioners and patients should be aware of these potential adverse effects. Prompt intervention is required to ensure recovery from vascular occlusion in these patients.