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Reversible Alopecia with Localized Scalp Necrosis After Accidental Embolization of the Parietal Artery with Hyaluronic Acid

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  • Non-Surgical Aesthetic
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Hyaluronic acid (HA) filler injection is widely used for soft-tissue augmentation. Complications associated with HA filling are not uncommon; however, HA-induced alopecia is a rarely reported complication that could result in severe secondary psychological trauma. The etiology, clinical traits, treatment strategies, outcomes, and possible reversibility of HA-induced alopecia have not been characterized. Here, we report a case in which bilateral temple injections of 6.5 mL of HA led to persistent pain over the left scalp for several days. Although the pain was relieved at day 9 after 600 U of hyaluronidase were injected in the left temple, the patient developed localized alopecia at the left temporoparietal region with central skin necrosis at day 15. After topical applications of recombinant bovine basic fibroblast growth factor gel and 2% minoxidil spay, the necrotic skin wound was healed at day 42. Hair regrowth and normal hair density were restored at day 74. Analyses of Doppler ultrasound examinations and histopathology of the skin biopsy suggested that mild ischemia of the left temporoparietal region led to reversible alopecia, while the permanent hair loss in the left parietal area was associated with severe skin ischemia. Therefore, the key to treatment would be to focus on the effective correction of severe ischemia-induced skin necrosis to prevent permanent hair loss.

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This study was supported by 2016 Intramural Science and Technology Development Foundation of Xijing Hospital, Fourth Military Medical University. The authors thank Dr. Dangjie Wu and Dr. Yuqian Li for the assistance with color Doppler ultrasound examination, Tantan Liu for histological analysis, and Xianhui Zeng for photograph collecting.

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Correspondence to Yingjun Su or Shuzhong Guo.

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None of the authors has a financial interest in any of the products or devices mentioned in this article.

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Qing Yang and Lihong Qiu contributed equally to this research and are co-first authors.

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Yang, Q., Qiu, L., Yi, C. et al. Reversible Alopecia with Localized Scalp Necrosis After Accidental Embolization of the Parietal Artery with Hyaluronic Acid. Aesth Plast Surg 41, 695–699 (2017).

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