Efficacy of Percutaneous Intraarterial Facial/Supratrochlear Arterial Hyaluronidase Injection for Treatment of Vascular Embolism Resulting From Hyaluronic Acid Filler Cosmetic Injection

Abstract

Background Vascular embolism is a serious complication of hyaluronic acid (HA) filler cosmetic injection and hyaluronidase injection has been proposed as the treatment. Until now there is a lack of adequate clinical evidence regarding the benefits of treatment for HA filler-induced vascular embolism by percutaneous facial or supratrochlear arterial hyaluronidase injection. Objectives To evaluate the efficacy of percutaneous facial or supratrochlear arterial hyaluronidase injection as a rescue treatment for HA filler-induced vascular embolism. Methods We included 17 patients with vascular embolism after facial HA filler injection. Intraarterial injection of 1500 units hyaluronidase was performed via facial artery for thirteen cases with skin necrosis and via supratrochlear arterial for four cases with severe ptosis and skin necrosis but no visual impairment. Simultaneously, the general symptomatic treatment and nutritional therapy were performed. Results After hyaluronidase injection, the facial skin necrosis in all cases was restored and the ptosis in the four cases was also significantly relieved. Patients were subsequently followed for 1 month to 1 year. The skin necrosis in 16 patients were completely healed and only 1 patient had small, superficial scars. Conclusions It is effective to alleviate the skin necrosis and ptosis resulting from HA filler embolism via percutaneous facial or supratrochlear arterial hyaluronidase injection.

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

“…Extravascular hyaluronidase was found to be most effective when given early (within 4 h), at high doses, and distributed over multiple treatment sessions [ 174 , 204 ]. Similarly, intravascular hyaluronidase was effective in the treatment of FIVO in the rabbit ear model, especially if injected within the first 4 h post injury, as well as in humans for the treatment of ischemic skin injuries [ 205 , 206 ].…”

“…Hyaluronidase therapy should be initiated promptly (ideally within the first 4 h post-injury), employ high doses, and be performed over multiple sessions spaced regularly over the first 24–48 h [ 119 , 146 ]. Treatment should immediately target underperfused regions demonstrating delayed capillary refill as well as any suspected sites of main arterial occlusion [ 150 , 174 , 206 ].…”

Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions

“…[14][15][16] However, emboli-induced skin necrosis and ptosis usually show a better prognosis after appropriate treatment. 17,18 Only a few cases of severe necrosis can be treated using full-thickness skin grafts. 15 In addition to ordinary fillers, we found that lidocaine and adrenaline solutions can induce intravascular embolisms and ultimately elicit blindness.…”

A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

“…It dissolves subcutaneous nodules and degrades HA correcting excessive quantities of injected HA fillers [41][42][43][44][45] and its duration of the activity is about 24-48 h in dermal tissues [10]. It can be used at a high dose of 200 U or higher for treating skin necrosis associated with HA filler injections, caused by vascular occlusion and sometimes intra-arterially as a thrombolytic to treat eye/intracranial complications [16], and often without hypersensitivity test [23].…”

“…Similarly, no evidence was found, in a form of RCTs, clinical trials, and retrospective case-control studies, on the management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with aesthetic HA filler injections; the available evidence was mainly retrospective case reports or case series. We have also listed the summary of 11 excluded studies [10,14,16,[56][57][58][59][60][61][62][63] in table 5. They were retrospective case series, with 5 cases or more, reporting on the use of hyaluronidase for managing aesthetic complications associated with aesthetic HA filler injection.…”