TABLE 1.

Signs and symptoms of vascular occlusion following cosmetic injections (Adapted from De Lorenzi3)

SIGNS/SYMPTOMS	TIME OF ONSET	CONSIDERATIONS
Pain	Immediate or seconds	Might be absent in the presence of local anaesthetics
Blanching	Immediate; might be transient	Phenomenon of blanching can be fleeting in nature due to assistance in perfusion from collateral vessels. Adrenaline in local anaesthetics can mimic and even disguise blanching associated with intravascular injection of soft tissue filler.
Livedo pattern	Minutes to tens of minutes	Skin color can be affected by ambient temperature, poor circulation, or preexisting medical conditions
Delayed capillary refill time	Minutes	Greater than three seconds suggestive of vascular compromise
Blue/grey appearance	Tens of minutes to hours	Due to the build-up of deoxygenated blood in the affected tissue
Skin breakdown	Days	Opportunistic anaerobic bacteria predominate due to the lack of oxygen in the tissues; choice of antibiotic needs to be considered.
Repair	Days to weeks	After epithelial integrity has been lost, repair begins via the method of secondary intention.