Nicolau syndrome appears after filling hyaluronic acid with the use of blanching technique

A 34-year-old woman was treated in our clinic for mild acne and scars. Two years before, oral isotretinoin was given to the patient with a complete healing of the acne but numerous 2–3-mm scars remained in both cheeks. Two sessions of a nonablative CO2 laser was performed one year after the termination of the isotretinoin treatment with partial improvement of the scars. After that, a blanching technique with hyaluronic acid was offered to the patient. She was injected with a low reticulated hyaluronic acid with lidocaine using a 30 Gy needle doing a blanching technique to fill the scars presented in her cheeks.