Abstract
Objective: Identify the most prevalent vascular complications caused by the injection of hyaluronic acid in orofacial harmonization and describe the intervention strategies to treat these complications. Bibliographic review: Embolization and vascular compression are the most serious forms of intercurrence in orofacial harmonization caused by large amounts of injected material, developing ischemia, necrosis and blindness. The application of hyaluronidase is still off-label to degrade hyaluronic acid in cases of vascular occlusion/compression, however, this enzyme is so far the only efficient option to reverse these complications, where its effect is incontestable in the best available evidence. Although hyaluronic acid fillers are well tolerated, an adequate understanding of clinical criteria and treatment protocols, mastery and technical competence to correct complications are essential elements for the safety of hyaluronic acid in orofacial harmonization. Final considerations: The knowledge of anatomy, the proper planning of treatment, as well as the early diagnosis and correct treatment of vascular complications (artery compression and embolization, necrosis, blindness) make facial harmonization procedures have predictable and efficient results.