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of immunological tissue reactions, as well as immunologically induced cell reactions both to the vein glue VenaSeal® (5.1% to 7.48% = 31% reduction) and to the micro-foam OVT (1,7% to 3,2% of all patients) we saw a decreased OVT rate of 46,9% reduction. Together with the decongestion therapy through the 12 - chamber compression, a real to achieve faster healing with comparatively significantly fewer side effects and complaints. So, we have two different therapy concepts with a clear synergy of effects - improvement of the microcirculation in the legs [11-18]. Disclosure The author did not have any potential conflict of interests. Thanks to my nurses Nina, Madlin and Nancy for their cooperation and intensive work in these cases! Muscle vein occlusion. This may lead to skin necrosis or permanent vision loss. The most important tool to detect an obstructed artery is duplex ultrasound. This imaging method may also aid in dissolving the causative filler material. Vascular ultrasound mapping prior to injection treatment may help prevent complications. Together with botulinum toxin, filler injections have become the most frequently performed cosmetic medical treatments[1]. In numbers these have surpassed cosmetic surgery by far. With little or no downtime and smaller risks of complications they offer obvious advantages over surgery. In western countries two type of filling substance can be distinguished. Most popular are the hyaluronic acid fillers with a 90% market share. These exert a direct volumizing effect. Hyaluronic acid is a natural substance that occurs in many human tissues and organs. It has an important water-binding capacity and regulatory functions. It has a life span of hours to several days and is continuously synthesized by a various cell types [2]. The Hyaluronic Acid (HA) used in fillers is synthesized by genetically modified bacteria. It is a copy of the human material. To overcome the short life span of the molecules, these are chemically modified by means of internal cross-linking. This technology makes it also possible to renders fillers with different chemico-physical properties in term of rheology, cohesiveness and elasticity. This gives manufacturers the opportunity to deliver different HA filler types for each indications, being either superficial lines, rhytids or sunken cheeks [3]. HA fillers have the enormous advantage of a dissolving substance, the enzyme hyaluronidase. Bio-stimulatory fillers pose the other group of fillers. These are intended to stimulate the body to form collagen. This process is part of a low grade inflammatory response. These filler are insoluble and need a carrier to deliver them from the syringe, through a needle into the tissue. Once inside the tissue these substances are broken down in several months [3]. Non-resorbable fillers consisting of moldable plastics form a third group of fillers. They stay permanently inside the tissue. The use of these has been banned in many countries. Another substance implicated in vascular occlusion is autologous fat. Fat transfer (also named lipofilling) is used for many kinds of bodily defect. The main cosmetic indications are facial defects in volume, small breast and buttocks. In particular the latter one has been implicated in a number of fatal embolisms [4]. In two surveys regarding vision loss after filler injection Beleznay, et al. noted that all types of fillers were implicated [5,6].It is plausible that this group of materials is identical to the causative agents in occlusion of major facial arteries. Vessels Arteries in the face primarily stem from the External Carotid Artery (ECA). In the lower and middle part of the face it is the facial artery branching from the ECA in the neck that crosses the mandibular bone ventrally and delivers branches to lower and upper lip before its course cranially alongside the nose to the forehead, with a namechange to angular artery. In the lateral middle part of the face the Velthuis PJ, et al. J Angiol Vasc Surg 2021, 6: 069 DOI: 10.24966/AVS-7397/100069 HSOA Journal of Angiology & Vascular Surgery Review Article Velthuis PJ* and Schelke LW Section of Cosmetic Dermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands Fillers and Vessels: The Story of Arterial Obstruction after
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