Treatment Algorithm for Hyaluronic Acid-Related Complication Based on a Systematic Review of Case Reports, Case Series, and Clinical Experience

Abstract

Study Design: Systematic review of hyaluronic acid (HA)-related complications. Objective: To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection. Methods: This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients. Results: The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects. Conclusion: Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection.

Using injectable fillers for chin and jawline rejuvenation

“…Should vascular infiltration occur, consensus guidelines recommend that patients receiving HA be promptly treated with hyaluronidase followed by an oral aspirin regimen 59 . While this complication is fortunately rare, a variety of algorithms for management of this complication have been developed 55,60,61 …”

“…59 While this complication is fortunately rare, a variety of algorithms for management of this complication have been developed. 55,60,61 There are several limitations to injectable fillers that must be mentioned. Despite an excellent safety profile, the efficacy of fillers is limited in patients with more severe chin retrusion.…”

Acute diplopia after glabellar hyaluronic acid filler injection

“…In contrast to previously proposed daily hyaluronidase injections and adjunct topical nitroglycerin and hyperbaric oxygen, 10 , 11 current recommendations for non-ophthalmic vascular complications utilize higher doses of hyaluronidase (without adjunctive therapies) to assure an effective concentration of hyaluronidase in the affected area to completely hydrolyze the filler. 12 , 13 , 14 Notably, topical nitroglycerin is no longer recommended since resultant vasodilation may lead to further embolization of filler. 15 It has been recommended that 500 units of hyaluronidase be injected into each affected area (e.g.…”

Recent progress and clinical applications of advanced biomaterials in cosmetic surgery

“…If the artery is occluded, immediate and severe pain occurs, while venous occlusion usually presents with a delayed reticular violet appearance. Due to the biodegradability of the product, the use of hyaluronidase can correct adverse reactions at the moment of injection or after injection [ 27 ].…”