Comparative Effectiveness of Different Interventions of Perivascular Hyaluronidase

Abstract

Background: Soft-tissue necrosis caused by vascular compromise is a frequent and troublesome complication of hyaluronic acid filler injection. Hyaluronidase has been proposed as a treatment for this condition. This study aimed to determine the effective dose and administration interval of hyaluronidase injection in a skin necrosis animal model. Methods: New Zealand rabbits were used to simulate the hyaluronic acid–associated vascular occlusion model. Hyaluronic acid filler (0.1 ml) was injected into the central auricular artery to create an occlusion. Three rabbit auricular flaps were injected with 500 IU of hyaluronidase once (group A) and three flaps each were injected at 15-minute intervals with 250 IU of hyaluronidase twice (group B), 125 IU of hyaluronidase four times (group C), 100 IU of hyaluronidase five times (group D), and 75 IU of hyaluronidase seven times (group E), all at 24 hours after occlusion. No intervention was administered after occlusion in the control group. Flap fluorescence angiography was performed immediately after hyaluronidase injection and on postoperative days 2, 4, and 7. Flap necrotic areas were analyzed. Results: All control and experimental flaps demonstrated total occlusion after hyaluronic acid injection. The average total survival rate (positive area/total area ×100 percent) of control flaps was 37.61 percent. For experimental groups, the average total survival rates were 74.83 percent, 81.49 percent, 88.26 percent, 56.48 percent, and 60.69 percent in groups A through E, respectively. Conclusion: A better prognosis can be obtained by administering repeated doses rather than a single high dose of hyaluronidase.

Prevention and Management of Filler Induced Iatrogenic Stroke of the Eye

“…When multiple sites are injected in which blindness occurs, glabella and nose have been treated in 54% of those treatment sessions. 17,18 Injections at these midline locations show no predilection for embolic passage toward one side or the other. There is one case report of bilateral blindness occurring with a single injection in the glabella.…”

Soft Tissue Filler Therapy and Informed Consent: A Canadian Review

“…The practitioner should obtain the patient's medical and surgical history, current medications, allergies and information about previous cosmetic or reconstructive facial procedures. [20][21][22] This knowledge informs the practitioner about the patient. In the clinic setting, it is expected that there will be documentation of the patient's goals, the practitioner's clinical evaluation and assessment, the plan for management and the treatment that was carried out.…”

Comments on “Hyaluronidase: an overview of its properties, applications, and side effects”

“…We thank the author for citing our previous article, which dealt with various interventions using perivascular hyaluronidase [5]. However, an important aspect is missing in this article [1]: the different types of hyaluronidase products.…”

“…Additionally, there are thousands of filler products with different hyaluronic acid concentrations, particle sizes, and cross-linking ratios and there are different guidelines for the amount of hyaluronidase to be used. In our previous paper, we recommended the injection of at least 100 IU of hyaluronidase at each site [5]. However, our injection guideline was based on the use of 1,500 IU hyaluronidase.…”