Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management.

Skin necrosis following the inadvertent arterial injection of hyaluronic acid (HA) is a serious complication. It is not clear whether or not subcutaneous injections of hyaluronidase decrease skin necrosis in HA-induced vascular complications. We had four cases of HA-induced vascular complications, two of which were treated with hyaluronidase the next day. All of the patients had skin necrosis and scarring. We performed an animal study with rabbit ears in which HA filler was injected into the auricular arteries of both ears. Five rabbits each received a subcutaneous injection of 750 IU of hyaluronidase 4 and 24 h after the filler injection. The hyaluronidase-treated ears in the 4-h intervention group had significantly smaller necrotic areas (p<0.05), while the 24-h intervention group had no differences in the area of necrosis. Hyaluronidase reduced the vascular complications of HA fillers when used early, but there was no benefit to hyaluronidase injection after 24 h.

[1]  H. Navsaria,et al.  Hyaluronic acid: the scientific and clinical evidence. , 2007, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[2]  N. Solish,et al.  Complications of hyaluronic acid fillers. , 2009, Facial plastic surgery : FPS.

[3]  T. Park,et al.  Clinical experience with hyaluronic acid-filler complications. , 2011, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[4]  B. Rzany,et al.  Hyaluronidase in the correction of hyaluronic acid‐based fillers: a review and a recommendation for use , 2009, Journal of cosmetic dermatology.

[5]  H. Brody.  Use of Hyaluronidase in the Treatment of Granulomatous Hyaluronic Acid Reactions or Unwanted Hyaluronic Acid Misplacement , 2005, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[6]  Byung-Soo Kim,et al.  Effect of cross-linking reagents for hyaluronic acid hydrogel dermal fillers on tissue augmentation and regeneration. , 2010, Bioconjugate chemistry.

[7]  L. Goldberg,et al.  Injection Necrosis of the Glabella: Protocol for Prevention and Treatment After Use of Dermal Fillers , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[8]  B. Rzany,et al.  Risk Profiles of Different Injectable Fillers: Results from the Injectable Filler Safety Study (IFS Study) , 2008, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[9]  Harikumar Menon,et al.  Low dose of Hyaluronidase to treat over correction by HA filler--a case report. , 2010, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[10]  J. Carruthers,et al.  Successful management of an unusual presentation of impending necrosis following a hyaluronic acid injection embolus and a proposed algorithm for management with hyaluronidase. , 2007, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[11]  Kotaro Yoshimura,et al.  Arterial embolization and skin necrosis of the nasal ala following injection of dermal fillers. , 2008, Plastic and reconstructive surgery.

[12]  S. Cox.  Clinical Experience With Filler Complications , 2009, Dermatologic Surgery.

[13]  R. Rhoades,et al.  Medical Physiology: Principles for Clinical Medicine , 2012 .

[14]  J. Dover,et al.  Management of Complications and Sequelae with Temporary Injectable Fillers , 2007, Plastic and reconstructive surgery.

[15]  Ashkan Ghavami,et al.  The Role of Hyaluronic Acid Fillers (Restylane) in Facial Cosmetic Surgery: Review and Technical Considerations , 2007, Plastic and reconstructive surgery.

[16]  Frank Bachmann,et al.  The Spectrum of Adverse Reactions After Treatment with Injectable Fillers in the Glabellar Region: Results from the Injectable Filler Safety Study , 2009, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[17]  Byung-Soo Kim,et al.  Control of the molecular degradation of hyaluronic acid hydrogels for tissue augmentation. , 2008, Journal of biomedical materials research. Part A.

[18]  Joel L Cohen.  Understanding, Avoiding, and Managing Dermal Filler Complications , 2008, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].