Immediate management of vascular occlusion

1Stop Treatment Immediately The most crucial step is to stop injecting any additional product as soon as the clinician observes that the blood supply to the region has been compromised. This is commonly a result of discomfort and blanching in the injected region. If feasible, aspirate any product while removing the needle or cannula. Additionally, it is the duty of the practitioner to notify the patient of the issue. If the practitioner is unsure or unskilled in the treatment of vascular occlusion, they should seek the counsel of a more experienced practitioner right away. A vascular blockage requires immediate attention since the danger of tissue injury, and skin necrosis grows as time passes.  
2Capillary refill time (CR)Calculate the time it takes for capillaries to refill (CRT).   This is the time it takes for the skin to restore its former colour after being squeezed.  This is done by placing moderate pressure to the area using a finger (or a small, flat object) for five seconds, followed by its release. It is vital to keep track of how long it takes for the skin to return to its natural colour. For comparison, the test should be carried out throughout the full area and on both the affected and unaffected sides A typical physiological capillary refill time for men and women under 65 is two and three seconds, respectively. For elderly patients, it can extend to four seconds for both men and women.  Therefore a CRT of three seconds or more may indicate vascular impairment.  If the patient has a rapid a rapid capillary refill time but blue skin colouring, this may indicate a venous occlusion.  It is good practice to therefore assess skin colour and capillary refill prior to treatment FuIf capillary refill time is slow but less than three seconds, a cautious approach should be utilized first. It may include the application of heat, massage therapy, or tapping. If conservative methods fail to increase capillary refill time OR CRT exceeds three seconds, practitioners should use the high-dose pulsed hyaluronidase procedure. 
3Massage the region firmly and Apply heat to the areaA firm, lengthy massage can help to improve blood flow and eliminate any obstructions created by a foreign body occluding a vessel. The time period of massage may extend from a few to several minutes. Vasodilation and increased blood flow to the area will be aided by the use of heat.Tapping the area: Intra-arterial emboli can be dislodged by tapping over a region, either at the location or farther up in the channel. 
4Inject Hyaluronidase  In the case of hyaluronic acid fillers, injecting with Hyaluronidase can alleviate the condition before complications arise. It’s important to note that this is a time-sensitive situation and that test patching isn’t necessary if Hyaluronidase is used to treat a vascular blockage because the risk of tissue damage is usually greater than the risk of allergy. As with any aesthetic procedure, it’s critical to have the right resuscitation equipment on hand in case something goes wrong.  There is some evidence that using Hyaluronidase after injecting a non-hyaluronic acid soft tissue filler will reduce eventual tissue injury by dissolving native hyaluronic acid and lowering blood supply pressure. Various practitioners tend to use the High-dose, Pulsed Hyaluronidase Protocol. This intervention is relatively simple but has effectively prevented necrosis in the nearly all cases even after 48hrs of the initial treatment. The intervention protocol entails injecting higher doses of Hyaluronidase into the entire compromised tissue area rather than just the site of filler. The process is repeated hourly until visible improvements are seen in terms of skin color, capillary refill, and pain reduction. This method has proved to be significantly beneficial even without any additional therapy and has yielded optimal results.  In the case of vascular occlusion, it is not imperative to inject Hyaluronidase directly into the vessel. By injecting hyaluronidase into the surrounding tissues this will dissolve the hyaluronic acid filler blocking the blood vessel. 
5Provide AspirinAspirin is known for its ability to hinder clot formation and platelet aggregation and prevent further vascular compromise. Thus, a stat dose of 300mg aspirin should be immediately provided. It can be followed by a dose of 75mg per day if no contraindications exist until the resolution of vascular occlusion. It should be noted that some patients with gastric sensitivity may require combination therapy with a gastro-protective agent