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

A case was reported where bilateral temple injections of 6.5 mL of hyaluronic acid (HA) led to persistent pain and subsequent localized alopecia with central skin necrosis in the left temporoparietal region. The pain was alleviated with 600 U of hyaluronidase, and the necrotic skin healed with topical recombinant bovine basic fibroblast growth factor gel and 2% minoxidil spray. Hair regrowth and normal density were restored by day 74. Doppler ultrasound and histopathology suggested that mild ischemia caused reversible alopecia, while severe ischemia led to permanent hair loss. Effective correction of severe ischemia-induced skin necrosis was crucial to prevent permanent hair loss.