swelling, pain, and pruritus, which must be distinguished from true arterial compromise.
Arterial compromise can occur either by direct injury to the vessel, compression of the vessel from nearby product, or arterial
embolization from product injected into a vessel. In order to minimize risk of arterial compromise, injections should be made superficially and slowly, after aspirating to ensure the needle is not in a vessel. Using a low volume of product over several treatment sessions can also minimize the risk.
The physician should be well educated in the signs of arterial compromise, including immediate blanching of surrounding skin, bluish or reticulated discoloration, and severe pain or swelling in the area. Early treatment of these symptoms may help prevent severe necrosis from developing.5
The immediate treatment mandated in these situations is to stop the injection, apply warm gauze to facilitate vasodilation, tap or massage the area to break up any product, intralesional hyaluronidase injections, and nitroglycerin paste 2% applied
