Polynucleotide (DOT-PN) for Accelerated Healing of Lip Necrosis After Filler-Induced Vascular Compromise

Abstract

Background: – Filler-induced vascular occlusion remains a rare but serious complication in aesthetic medicine, particularly in the lips, where collateral circulation is limited. Polynucleotide (DOT-PN) is a polynucleotide-based medical device primarily characterized by its hydration capacity and viscoelastic properties. When administered intradermally, PN provides structural support to the extracellular matrix (ECM) and contributes to the optimization of the local tissue microenvironment. Such ECM-level modulation may create conditions favorable for tissue stabilization and secondary vascular recovery following ischemic injury. Methods: – We report a case involving a 41-year-old woman with upper lip necrosis following hyaluronic acid filler injection. Initial treatment with hyaluronidase partially alleviated ischemia but failed to prevent necrosis. Polynucleotide (DOT-PN; a polynucleotide-based medical device; PharmaResearch Co., Ltd.; Seoul, Republic of Korea)) was administered intradermally in 4 sessions at 8-hour intervals (q8h×4), alongside conservative wound care. Results: – Clinical improvement was observed within 36 hours of the first PN injection. The lesion demonstrated progressive improvement in tissue color, epithelial continuity, and surface integrity over a 4-week period, with no scarring or adverse events. Patient-reported satisfaction was rated 9 out of 10, with minimal pain and no functional sequelae during follow-up. Conclusion: – Further controlled studies are warranted to define optimal PN dosing intervals, timing of administration, and comparative effectiveness versus other adjunctive treatments for filler-induced ischemic complications. Copyright © 2025 by Mutaz B. Habal, MD