Treatment of hyaluronic acid filler-induced impending necrosiswith hyaluronidase

Consensus recommendations

Joel L. Cohen, Brian S. Biesman, Steven H. Dayan, Claudio De Lorenzi, Val S. Lambros, Mark S. Nestor, Neil Sadick, Jonathan M Sykes

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Injection-induced necrosis is a rare but dreaded consequence of soft tissue augmentation with filler agents. It usually occurs as a result of injection of filler directly into an artery, but can also result from compression or injury. We provide recommendations on the use of hyaluronidase when vascular compromise is suspected. Consensus recommendations were developed by thorough discussion and debate amongst the authors at a roundtable meeting on Wednesday June 18, 2014 in Las Vegas, NV as well as significant ongoing written and verbal communications amongst the authors in the months prior to journal submission. All authors are experienced tertiary care providers. A prompt diagnosis and immediate treatment with high doses of hyaluronidase (at least 200 U) are critically important. It is not felt necessary to do a skin test in cases of impending necrosis. Some experts recommend dilution with saline to increase dispersion or lidocaine to aid vasodilation. Additional hyaluronidase should be injected if improvement is not seen within 60 minutes. A warm compress also aids vasodilation, and massage has been shown to help. Some experts advocate the use of nitroglycerin paste, although this area is controversial. Introducing an oral aspirin regimen should help prevent further clot formation due to vascular compromise. In our experience, patients who are diagnosed promptly and treated within 24 hours will usually have the best outcomes.

Original languageEnglish (US)
Pages (from-to)844-849
Number of pages6
JournalAesthetic Surgery Journal
Volume35
Issue number7
DOIs
StatePublished - 2015

Fingerprint

Hyaluronoglucosaminidase
Hyaluronic Acid
Consensus
Vasodilation
Blood Vessels
Necrosis
Injections
Massage
Nitroglycerin
Tertiary Healthcare
Ointments
Lidocaine
Skin Tests
Aspirin
Therapeutics
Arteries
Communication
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Treatment of hyaluronic acid filler-induced impending necrosiswith hyaluronidase : Consensus recommendations. / Cohen, Joel L.; Biesman, Brian S.; Dayan, Steven H.; De Lorenzi, Claudio; Lambros, Val S.; Nestor, Mark S.; Sadick, Neil; Sykes, Jonathan M.

In: Aesthetic Surgery Journal, Vol. 35, No. 7, 2015, p. 844-849.

Research output: Contribution to journalArticle

Cohen, JL, Biesman, BS, Dayan, SH, De Lorenzi, C, Lambros, VS, Nestor, MS, Sadick, N & Sykes, JM 2015, 'Treatment of hyaluronic acid filler-induced impending necrosiswith hyaluronidase: Consensus recommendations', Aesthetic Surgery Journal, vol. 35, no. 7, pp. 844-849. https://doi.org/10.1093/asj/sjv018
Cohen, Joel L. ; Biesman, Brian S. ; Dayan, Steven H. ; De Lorenzi, Claudio ; Lambros, Val S. ; Nestor, Mark S. ; Sadick, Neil ; Sykes, Jonathan M. / Treatment of hyaluronic acid filler-induced impending necrosiswith hyaluronidase : Consensus recommendations. In: Aesthetic Surgery Journal. 2015 ; Vol. 35, No. 7. pp. 844-849.
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