Supplementary Material for: Needling as a potential and novel treatment for skin ischemia following filler-induced vascular occlusion: A case series

Background: The most severe complication of filler injection is ischemia due to vascular occlusion, causing skin necrosis, scarring, blindness, even stroke. Despite the existence of numerous treatment options such as hyaluronidase, oxygen therapy and corticosteroids, clinical practice still faces substantial difficulties and demands intricate and comprehensive management. Thus, more methods remain under research. Among them, needling therapy has been used in some clinical practices but rarely studied and discussed. Objectives: The objective was to evaluate the efficacy and safety of needling procedure for filler-induced skin ischemia, which is unresponsive to standard therapies. Methods: Four recent skin ischemia cases with subsequent needling procedure were observed retrospectively and pertinent literature was analyzed. Results: All of the four cases recovered from skin ischemia without side effects by receiving needling procedure. The available data demonstrate some potential mechanisms of needling, such as embolus releasing, ischemia reperfusion and revascularization. Conclusion: Although there is a lack of conclusive evidence for improving the hypoperfusion area by needling treatment, the current cases observation and theoretical analysis as well as our cases provide evidence supporting its potential as an efficacious, simple, and secure treatment for vascular complications.