The Effect of Hyaluronidase on Depth of Necrosis in Hyaluronic Acid Filling-Related Skin Complications

Aim In this clinical study, 16 female patients with vascular compression and occlusion-related ischemia and skin necrosis after hyaluronic acid filling injection were analyzed retrospectively. Dose, timing, and efficacy of hyaluronidase use in skin necrosis are discussed. Patients and Methods In a total of 841 cases, aged between 18 and 60 years, hyaluronic acid filling injections were performed. All patients were followed up for 3–24 months. Filling injected areas include nasolabial (391 cases), lip (225 cases), glabella–forehead (90 cases), infraorbital (46 cases), malar region (25 cases), chin (24 cases), and nose (40 cases). Skin complications occurred in four cases during the application and in 12 cases 6–24 h after the procedure. Only palliative treatment was performed in six cases, while hyaluronidase was used in 10 cases in addition to palliative treatment. Hyaluronidase injection was performed 30 s after filling injection in four cases and 6–24 h after the injection in the remaining six cases. A total of 1500 units of hyaluronidase was applied to each case in average. Results Recovery period of the patients who received palliative treatment only lasted 40–60 days. The area of necrosis was limited in these patients who did heal well only with some change of pigmentation and no obvious scar. In the patient group who received hyaluronidase in addition to palliative treatment, a large necrosis area was observed at the same time in four patients. Despite the hyaluronidase treatment in this group, recovery period was 20–90 days. The affected and necrosis areas were large. The cause of ischemia depended both on occlusion and on compression. While four patients healed with a scar, the remaining 12 patients healed without any significant scar. Conclusions Hyaluronidase injection provides earlier recovery of limited skin necrosis. Immediate hyaluronidase injection allows small damage to heal in a short time; however, it does not completely eliminate large necrosis, although it limits the necrotic area. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. 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 .