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Percutaneous Intra-arterial Hyaluronidase Injection for Hyaluronic Acid Filler Embolism Threatening Skin Barrier Integrity: Implementation of a Stepwise Treatment Protocol

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Abstract

Background

Hyaluronic acid (HA) filler-induced vascular embolism that threatens skin integrity is an urgent situation. There is increasing evidence that percutaneous intra-arterial hyaluronidase injection is an effective therapeutic technique for it. However, until now, there is a lack of a unifying protocol about the technique.

Objectives

This study aims to provide a conclusion of percutaneous intra-arterial hyaluronidase injection along with adjunctive measures on the treatment of occlusions precipitated by HA-based filler and develop a stepwise treatment protocol.

Methods

We searched PubMed for peer-reviewed studies, consensus statements, case series, and case reports using a variety of keywords.

Results

High-dose, pulsed hyaluronidase is the mainstay for the treatment of HA filler-induced embolism, but percutaneous intra-arterial hyaluronidase injection is a more effective technique. Until now, hyaluronidase is injected into three arteries percutaneously, including facial artery, supratrochlear artery, and superficial temporal artery. Furthermore, the adjunctive measures that may optimize clearance of an occlusion and/or skin barrier repair such as the use of image guidance and CGF should be considered.

Conclusion

Vascular occlusions that threaten skin integrity are an urgent matter which requires accurate diagnosis and effective intervention. Percutaneous intra-arterial hyaluronidase injection along with adjunctive measures performed in a stepwise manner is key to an optimal outcome.

No Level Assigned

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Authors and Affiliations

  1. Plastic and Reconstructive Surgery Unit, Department of Burns and Plastic Surgery, Fourth Medical Center, PLA General Hospital, 51 Fucheng Rd., Beijing, 100048, People’s Republic of China

    Qiang Fu, Can Zheng, Gui-wen Zhou & Min-liang Chen

  2. Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, People’s Republic of China

    Xiao Xu

  3. Zhifu Medical Beauty Clinic, Beijing, People’s Republic of China

    Lin-ying Lai

  4. Medical School of Chinese PLA, Beijing, People’s Republic of China

    Xu-er Sun, Li-xia Zhang, Qian Wu, Hong-fan Ding, Yi Yang & Hui-juan Fu

Authors
  1. Qiang Fu
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  2. Can Zheng
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  3. Gui-wen Zhou
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  4. Xiao Xu
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  5. Lin-ying Lai
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  9. Hong-fan Ding
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  11. Hui-juan Fu
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  12. Min-liang Chen
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Correspondence to Min-liang Chen.

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Fu, Q., Zheng, C., Zhou, Gw. et al. Percutaneous Intra-arterial Hyaluronidase Injection for Hyaluronic Acid Filler Embolism Threatening Skin Barrier Integrity: Implementation of a Stepwise Treatment Protocol. Aesth Plast Surg 48, 747–751 (2024). https://doi.org/10.1007/s00266-023-03640-4

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  • DOI: https://doi.org/10.1007/s00266-023-03640-4

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