Approximately 12 hours after accidental intra-arterial injection of hyaluronic acid filler into the labial artery, this 25-year-old woman presented with severe pain and extreme tenderness of the area; she would not allow examination until after administration of a local nerve block. Following anesthesia, examination showed extremely slow capillary refill after digital compression, interpreted as arterial insufficiency. The physician promptly treated the patient with hyaluronidase (HYAL) injections into the ischemic regions, followed by massage. The patient made a complete recovery without scarring. (Photo courtesy of Dr Nowell Solish, Associate Professor of Dermatology, University of Toronto, Ontario, Canada)