ArticleAesthetic surgery journal. Open forum2026
Staged Management of Vascular Occlusion With Ellansé (Polycaprolactone): A Modified Delphi Expert Consensus.
Article in Aesthetic surgery journal. Open forum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Vascular occlusion (VO) is a rare but serious complication of dermal filler injection. Current management protocols are derived primarily from hyaluronic acid fillers and rely on enzymatic degradation with hyaluronidase. Ellansé (PCL-CMC) is a poly-ε-caprolactone (PCL)-based filler composed of PCL microspheres suspended in a carboxymethyl cellulose (CMC) gel carrier, neither of which is a substrate for hyaluronidase; a product-specific management approach is therefore required. Objectives: To develop expert consensus recommendations for the recognition and management of VO associated with PCL-CMC. Methods: A targeted literature review (PubMed, January 2009-August 2025), in vitro rheometry and flow testing, and a three-round modified Delphi consensus process involving seven international experts were used to develop a staged management algorithm. Results: At 1:5 dilution, PCL-CMC viscosity decreased approximately 80-fold to near-aqueous levels; hyaluronidase solution conferred no additional benefit over saline alone. A full consensus or a consensus based on majority of the experts consensus (≥80%) was achieved on the majority of statements, including CMC-mediated obstruction as the primary mechanism, high-volume saline flushing with mechanical dispersion as first-line therapy, and retention of hyaluronidase in a supportive role. Conclusions: This consensus-derived algorithm prioritizes reperfusion through dilution and mechanical dispersion rather than enzymatic degradation. Prospective clinical validation is required. Level of Evidence 5 Therapeutic: For image description, please refer to the figure legend and surrounding text.
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