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

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Abstract

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.

Original languageEnglish
Pages (from-to)1590-1595
Number of pages6
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume64
Issue number12
DOIs
Publication statusPublished - 2011 Dec 1

Fingerprint

Hyaluronoglucosaminidase
Hyaluronic Acid
Blood Vessels
Necrosis
Ear
Subcutaneous Injections
Skin
Injections
Rabbits
Cicatrix
Arteries

Keywords

  • Complication
  • Hyaluronic acid
  • Hyaluronidase
  • Skin necrosis

ASJC Scopus subject areas

  • Surgery

Cite this

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abstract = "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.",
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author = "Deok-Woo Kim and Yoon, {Eul Sik} and Ji, {Yi Hwa} and Park, {Seung Ha} and Byung-Il Lee and Eun-Sang Dhong",
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AU - Kim, Deok-Woo

AU - Yoon, Eul Sik

AU - Ji, Yi Hwa

AU - Park, Seung Ha

AU - Lee, Byung-Il

AU - Dhong, Eun-Sang

PY - 2011/12/1

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N2 - 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.

AB - 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.

KW - Complication

KW - Hyaluronic acid

KW - Hyaluronidase

KW - Skin necrosis

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