This is a case of vascular adverse event. The initial presentation was 15 hours after injection. Patient had livedo reticularis and slight pain and numbness of cheek. She was injected with Lyft with both needle and cannula in medial cheek. Ultrasound shows filler in infraorbital foramen causing spasm of her palpebral branch of the infraorbital artery and infraorbital artery. There is a pocket of filler on bone which is not causing problems to the left on the images. The discontinuity of the vessel I interpret as spasm. Looking higher in tissue, you see there is very poor vascualrity of subcutaneous tissue. Capillary refill was < 3 seconds. After careful consideration this was treated conservatively with observation, aspirin, and steroids. The injector place lidocaine with cannula to see if spasm would respond. No significant changes were noted. One small injection with cannula of 75u of Hylenex was placed as well (probably not a significant amount and done by the patients injector without ultrasound guidance). The following day, the artery had more flow and the skin appeared better. So at day 2, @platedskinscience exosomes were started and the picture/selfie from patient showed complete resolution of skin changes at day 3. I believe that spasm played a big role in this case and since skin didn’t appear too compromised, conservative measures were acceptable. Ultrasound showed there was flow, but not normal (spasm) but was reassuring. Not all occlusions need flooding with Hylenex. There is a threshold that needs to be exceeded to cause tissue loss. If the skin can tolerate the compromised flow long enough to have collaterals take over or the artery to stop spasm, then aggressive measures can be avoided. This patient was observed closely and is an injector, so that was also in our favor.