A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series
IntroductionHyaluronic acid (HA) fillers are generally safe; however, the most significant complication is vascular occlusion. Several therapeutic protocols have been proposed for managing ischemia. De Lorenzi introduced the HDPH protocol, which uses a minimum of 500 IU of hyaluronidase (HYAL) per i...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1585983/full |
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| author | Shahriar Nazari Nabil Fakih-Gomez Nabil Fakih-Gomez Nima Hadadian Foroohe Bayat Behnam Bohlouli Cristina Muñoz-Gonzalez Cristina Muñoz-Gonzalez Mohammad Reza Pourani |
| author_facet | Shahriar Nazari Nabil Fakih-Gomez Nabil Fakih-Gomez Nima Hadadian Foroohe Bayat Behnam Bohlouli Cristina Muñoz-Gonzalez Cristina Muñoz-Gonzalez Mohammad Reza Pourani |
| author_sort | Shahriar Nazari |
| collection | DOAJ |
| description | IntroductionHyaluronic acid (HA) fillers are generally safe; however, the most significant complication is vascular occlusion. Several therapeutic protocols have been proposed for managing ischemia. De Lorenzi introduced the HDPH protocol, which uses a minimum of 500 IU of hyaluronidase (HYAL) per ischemic area.Materials and methodsThis case series study evaluates the efficacy of a novel protocol, “THIS and FAT,” for managing ischemia resulting from filler-induced vascular occlusion (FIVO). The protocol builds on elements from previous approaches while introducing combination therapies specifically tailored to address ischemia. The therapeutic regimen includes T: botulinum toxin type A (BTX-A), H: high-dose HYAL, I: injectable platelet-rich fibrin (iPRF), S: serum platelet-rich fibrin (sPRF), a: aspirin and antibiotics, n: nanofat, d: debridement and dermabrasion, and F: fat membrane application.ResultsA total of 25 eligible patients, including 20 women and 5 men with a mean age of 32.36 ± 6.71 years, were included. The THIS and FAT protocol involved the injection of BTX-A and HYAL, with mean doses of 50.68 ± 60.79 Units and 5970.0 ± 2791.65 IU, respectively. Additionally, iPRF and sPRF were applied to the ischemic wound surface. Debridement was performed for ischemia classified as stage three or higher. Notably, 92% of patients treated with the THIS and FAT protocol showed complete improvement without scar formation.Conclusion“THIS and FAT” Protocol for managing ischemia following FIVO shows promising outcomes. Additionally, wound management with fat membrane, iPRF injections, sPRF dressing, and nanofat application resulted in favorable outcomes in this case series. |
| format | Article |
| id | doaj-art-59f4e6aea1a44d83a34ccc1e4506c3ea |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-59f4e6aea1a44d83a34ccc1e4506c3ea2025-08-20T02:46:17ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.15859831585983A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case seriesShahriar Nazari0Nabil Fakih-Gomez1Nabil Fakih-Gomez2Nima Hadadian3Foroohe Bayat4Behnam Bohlouli5Cristina Muñoz-Gonzalez6Cristina Muñoz-Gonzalez7Mohammad Reza Pourani8Department of ENT and Head and Neck Surgery, BMI Hospital, Tehran, IranDepartment of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, LebanonDepartment of Surgery, Universidad de Salamanca, Salamanca, SpainSchool of Medicine, Tabriz University of Medical Sciences, Tabriz, IranSchool of Medicine, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, IranOral and Maxillofacial Surgery, University of Toronto, Toronto, ON, CanadaDepartment of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, LebanonDepartment of Surgery, Universidad de Salamanca, Salamanca, SpainSkin Research Center, Shohada-e Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranIntroductionHyaluronic acid (HA) fillers are generally safe; however, the most significant complication is vascular occlusion. Several therapeutic protocols have been proposed for managing ischemia. De Lorenzi introduced the HDPH protocol, which uses a minimum of 500 IU of hyaluronidase (HYAL) per ischemic area.Materials and methodsThis case series study evaluates the efficacy of a novel protocol, “THIS and FAT,” for managing ischemia resulting from filler-induced vascular occlusion (FIVO). The protocol builds on elements from previous approaches while introducing combination therapies specifically tailored to address ischemia. The therapeutic regimen includes T: botulinum toxin type A (BTX-A), H: high-dose HYAL, I: injectable platelet-rich fibrin (iPRF), S: serum platelet-rich fibrin (sPRF), a: aspirin and antibiotics, n: nanofat, d: debridement and dermabrasion, and F: fat membrane application.ResultsA total of 25 eligible patients, including 20 women and 5 men with a mean age of 32.36 ± 6.71 years, were included. The THIS and FAT protocol involved the injection of BTX-A and HYAL, with mean doses of 50.68 ± 60.79 Units and 5970.0 ± 2791.65 IU, respectively. Additionally, iPRF and sPRF were applied to the ischemic wound surface. Debridement was performed for ischemia classified as stage three or higher. Notably, 92% of patients treated with the THIS and FAT protocol showed complete improvement without scar formation.Conclusion“THIS and FAT” Protocol for managing ischemia following FIVO shows promising outcomes. Additionally, wound management with fat membrane, iPRF injections, sPRF dressing, and nanofat application resulted in favorable outcomes in this case series.https://www.frontiersin.org/articles/10.3389/fmed.2025.1585983/fullhyaluronic acidischemiahyaluronidasenecrosisfat membranenanofat membrane |
| spellingShingle | Shahriar Nazari Nabil Fakih-Gomez Nabil Fakih-Gomez Nima Hadadian Foroohe Bayat Behnam Bohlouli Cristina Muñoz-Gonzalez Cristina Muñoz-Gonzalez Mohammad Reza Pourani A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series Frontiers in Medicine hyaluronic acid ischemia hyaluronidase necrosis fat membrane nanofat membrane |
| title | A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series |
| title_full | A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series |
| title_fullStr | A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series |
| title_full_unstemmed | A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series |
| title_short | A new protocol (THIS and FAT) for the treatment of filler-induced vascular occlusion: a case series |
| title_sort | new protocol this and fat for the treatment of filler induced vascular occlusion a case series |
| topic | hyaluronic acid ischemia hyaluronidase necrosis fat membrane nanofat membrane |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1585983/full |
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