Early hyaluronidase use in preventing skin necrosis after treatment with dermal fillers: Report of two cases

Abstract

Injection of dermal fillers, like hyaluronic acid (HA), is a safe procedure, with few and transient side effects such as erythema, bruising and swelling etc. The aim of this report is to provide our protocol for the early treatment of necrotic complications after facial treatment with dermal fillers. We present two cases of skin suffering of the face after dermal infiltration of HA, treated successfully with our early protocol. Our protocol includes the early infiltration of hyaluronidase in the treated areas. We start with infiltration of hyaluronidase distributed over the area to be treated through micro-injections with dosage 40 IU per cm2. Our protocol includes the use of systemic corticosteroids for 4 days, anti-aggregation therapy, oral antibiotic, topical cream with nitric oxide and compresses with gauze and warm water. In the skin complications after dermal filler treatment, marked pain and characteristic reticulated erythema in the skin distribution of the affected vessels is often developed. Due to the implementation of our protocol in these patients, we managed to avoid an irreversible necrotic complication of the face in both cases. In this report, our protocol was compared with results published in the literature and allowed us to avoid complications such as skin necrosis with permanent damage.

Vascular Occlusion in Lip Filler: A Clinical Case Report

“…O uso de hialuronidase é o mais efetivo tratamento e, portanto, deve ser a primeira medida a ser aplicada nos casos de suspeita de isquemia. (BRAVO et al ., 2020) Nas situações em que o diagnóstico não tenha sido realizado no período ideal para a aplicação da hialuronidase com vistas à reversão da oclusão, agravando-se o problema para uma necrose tecidual, o uso da substância deve ser associada à prescrição de fármacos como Cefalexina 500 mg 6/6h por 7 dias, Citrato de Sildenafila 50 mg 12/12h por 7 dias, Pentoxifilina 400 mg 8/8h por 7 dias e debridamento químico com Dermacerium e sessões de oxigenoterapia hiperbárica; ácido acetilsalicílico de 100 mg; Levofloxacina de 500 mg a cada 24h por 4 dias enquanto houver a presença de vesículas ou tecido necrótico para impedir a instalação de infecções oportunistas; Prednisona 25mg / 24h por dia visando diminuir o edema e aumentar a microcirculação; creme de Óxido de zinco 8/8h para melhorar a perfusão sanguínea e compressa com gaze e água morna (CIANCIO et al, 2019;DELORENZI, 2017;FURTADO, et al, 2020).…”

Diagnóstico e Tratamento das Complicações Vasculares em Harmonização Orofacial: revisão e atualização da literatura

“…Prednisona 25mg / 24h por dia visando diminuir o edema e aumentar a microcirculação. Ácido acetilsalicílico 100 mg como antiplaquetário, creme de Óxido de zinco 8/8h para melhorar a perfusão sanguínea e compressa com gaze e água morna (CIANCIO F, et al, 2019).…”

Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review

“…Topical nitropaste under occlusion, oral acetylsalicylic acid (aspirin), warm compresses, and vigorous massage are also useful. Secondary lines of treatment may involve intra-arterial hyaluronidase, hyperbaric oxygen therapy, and ancillary vasodilating agents (prostaglandin E1) [40,[56][57][58][59]. At all, reported management strategies vary greatly from surgeons and there is no treatment that is consistently successful [41].…”