Hyaluronidase Injection Research Articles

Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers

Hyaluronic acid fillers are known for a reliable safety profile, but complications do occur, even serious vascular adverse events. To improve the treatment outcome after a vascular adverse event with use of hyaluronic acid filler treatments. Duplex ultrasonography is used to detect the hyaluronic acid filler causing the intra-arterial obstruction. If treated in time, 1 single treatment of ultrasonographically guided injections of hyaluronidase into the filler deposit will prevent skin necrosis. Because the use of duplex ultrasonography adds extra essential information, its use may become an integral part of the prevention and treatment of injection adverse events.

Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection.

Blindness caused by soft-tissue filler injection is the most tragic complication, with no standard treatments until recently. Retrobulbar hyaluronidase injection has been proposed as the treatment, but its effectiveness in visual compromise remains to be determined. The authors aimed to determine the effectiveness of retrobulbar hyaluronidase using soft-tissue filler in an iatrogenic blindness animal model. New Zealand White rabbits were used to simulate the hyaluronic acid-associated vascular occlusion model. A volume of 0.7 to 1.6 ml of hyaluronic acid filler was injected into the internal carotid artery to create a retinal artery occlusion. The rabbits were administered retrobulbar hyaluronidase (3000 IU) at different postobstruction time points (5 and 10 minutes). No intervention was given to the control group. Fundus photography was performed before and immediately after the filler injection and immediately after the administration of retrobulbar hyaluronidase. Electroretinography was performed after 60 minutes to confirm the retinal reperfusion and electrophysiologic function. All of the experimental eyes recorded total occlusion after hyaluronic acid injection. Three eyes with a completely occluded retinal artery following retrobulbar hyaluronidase treatment showed improved retinal reperfusion by fundus photography and corresponding electroretinography. Despite administration of the retrobulbar hyaluronidase injection, one completely occluded eye showed no improvement in perfusion. All of the control eyes recorded complete occlusion 1 hour after hyaluronic acid filler injection. Retrobulbar hyaluronidase may be an effective evidence-based treatment option for humans. Hyaluronidase concentration and injection time are the important factors for faster recovery, but additional studies are still required.

An In Vitro Model Assessing the Penetration of Hyaluronidase through Optic Nerve Dura for Management of Hyaluronic Acid Facial Filler Embolism.

Blindness from ophthalmic or central retinal artery embolism is one of the most devastating complications of cosmetic filler facial injections. A proposed therapy to mitigate visual loss is prompt retrobulbar injection of hyaluronidase into the retrobulbar space. Despite Zhu et al. showing a lack of evidence and very limited published literature for reversing visual loss with this intervention, it is still widely accepted as a treatment for filler-related emboli. The purpose of this study was to evaluate the penetration of hyaluronidase through optic nerve dura using an in vitro model. At study conclusion, five 1-cm-long segments of fresh optic nerve were obtained and injected with highly crosslinked hyaluronic acid filler, then ligated on both ends in a watertight fashion. The sections were immersed in three concentrations of hyaluronidase solution for 24 hours. Histopathologic examination of the specimen was performed to assess the presence of filler. The optic nerve sections were 1.1 cm (range, 0.8 to 1.2 cm). Three were immersed in 20 ml of 1500 IU/ml hyaluronidase solution and two were immersed in saline as control. After 24 hours, there was a persistence of hyaluronic acid within the optic nerves. There is a lack of evidence for penetration of optic nerve sheath by hyaluronidase. This raises question about the effectiveness of retrobulbar injection of hyaluronidase in reversing filler-related blindness. Further studies are needed before this can be adopted as the treatment of choice. Therapeutic, V.

Discussion: Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection.

Discussion: Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection.

The Role of Hyaluronidase for the Skin Necrosis Caused by Hyaluronic Acid Injection-Induced Embolism: A Rabbit Auricular Model Study.

Skin necrosis is considered the most serious complication of hyaluronic acid dermal filler injection procedures. To effectively treat skin necrosis, hyaluronidase injection is one of the essential preventative treatments, and yet optimal complication management remains an unmet need. Therefore, this paper investigates the effects of hyaluronidase injection timing on the treatment of skin necrosis. In an in vitro experiment, the carbazole method was used to determine the degradation time of hyaluronic acid gels in a large volume of hyaluronidase. In vivo experimental rabbit ear models were developed to simulate the skin necrosis caused by hyaluronic acid and the test animals distributed into five groups. Except one control group, the other four groups were injected with a large volume of hyaluronidase as treatment at 2h, 4h, 8h and 16h, respectively, after models were built. The necrosis degree of models was analyzed with necrotic area and histologic examination on the postoperative 7th day. Besides, temperatures of rabbit ears were observed to demonstrate the healing process of flap models. The average necrotic area of flaps in the 2-h and 4-h injection groups showed a significant difference compared with that of the control group (p < 0.05; p < 0.05). The histologic examination showed that there were HA embolisms, vascular thrombolytic recanalization and arteriovenous thromboses in the survival area. In addition, the mean temperatures of the rabbit ear flaps fluctuated over time and showed clear differences between distal and proximal parts. The area of flap necrosis positively correlates with injection timing of the large volume of hyaluronidase. More importantly, when injection timing is within 4h, treatment effectiveness will be significantly improved. 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 .

Double intra venous cannula versus single needle technique of aspiration and methylprednisolone injection in the treatment of wrist ganglion: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ganglion is the one of the common soft tissue swellings in the hand and wrist. Treatment options available include reassurance, nonsurgical means like aspiration with or without steroid or hyaluronidase injection and surgical or arthroscopic excision. All current treatment options produce suboptimal results. This study endeavours to compare the outcome and recurrence rate and other complications after treatment of wrist ganglion by aspiration and methylprednisolone injection by double Intravenous cannula versus single needle technique.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective comparative clinical study was done with a total of 72 patients. 36 patients in group 1 were treated with double intravenous cannula technique and 36 patients in group 2 were treated with single needle technique. All the patients were followed up for 6 months to look for recurrence and any complication. The patient’s age, sex and various characteristics of the ganglion cyst like side, site, size, etc. were recorded.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In group 1, recurrence was seen in 6 patients (15.7%) while in group 2, recurrence were seen in 14 (38.8%) patients. There was statistical significant difference between the two groups with p value of 0.04. No complication was seen in both groups due to methylprednisolone injection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Inspired by the results we advise to use aspiration and methylprednisolone injection by double intravenous cannula technique in the treatment of wrist ganglion before any surgical intervention. It is safe, simple, cost effective method and is less invasive and less time consuming with recurrence rate comparable to surgical and arthroscopic interventions.&lt;/p&gt;

Rehabilitation of the Dysmorphic Lower Eyelid From Hyaluronic Acid Filler: What to Do After a Good Periocular Treatment Goes Bad.

Chronic, long-lasting edema accompanied by the Tyndall effect as a delayed reaction to hyaluronic acid (HA) filler injection seems to occur exclusively in the eyelids. The authors sought to present a treatment algorithm for management of patients with chronic lower eyelid edema as a delayed complication of HA filler injection. Retrospective study including 61 patients with delayed-onset chronic periocular edema following uneventful HA filler injection in the lower eyelids or cheeks. All patients underwent hyaluronidase enzyme dissolution followed by secondary treatment. Three retreatment options were presented: (1) observation, (2) secondary treatment with HA filler, and (3) lower eyelid blepharoplasty. All patients underwent filler dissolution using hyaluronidase. The mean age was 48 years and 97% of the patients were female. Single treatment was effective in 92% of patients with 8% requiring another hyaluronidase injection to completely eradicate residual edema. Six patients (10%) were satisfied after hyaluronidase only and 6 patients (10%) underwent lower eyelid blepharoplasty. Secondary treatment with HA filler was performed in 48 patients (80%). All were satisfied with final results without further edema in the follow-up period. Delayed-onset chronic lower eyelid edema is a frequent HA-related complication and cause of concern when considering periocular HA treatment. Previous treatment has been limited to either hyaluronidase only or blepharoplasty as a secondary solution after hyaluronidase, with only a minority of patients satisfied. Hyaluronidase, shortly followed by HA filler retreatment, is a safe and effective solution.

IL-6 release from muscles during exercise is stimulated by lactate-dependent protease activity.

IL-6 is secreted from muscles to the circulation during high-intensity and long-duration exercise, where muscle-derived IL-6 works as an energy sensor to increase release of energy substrates from liver and adipose tissues. We investigated the mechanism involved in the exercise-mediated surge in IL-6 during exercise. Using interval-based cycling in healthy young men, swimming exercise in mice, and electrical stimulation of primary human muscle cells, we explored the role of lactate production in muscular IL-6 release during exercise. First, we observed a tight correlation between lactate production and IL-6 release during both strenuous bicycling and electrically stimulated muscle cell cultures. In mice, intramuscular injection of lactate mimicked the exercise-dependent release of IL-6, and pH buffering of lactate production during exercise attenuated IL-6 secretion. Next, we used in vivo bioimaging to demonstrate that intrinsic intramuscular proteases were activated in mice during swimming, and that blockade of protease activity blunted swimming-induced IL-6 release in mice. Last, intramuscular injection of the protease hyaluronidase resulted in dramatic increases in serum IL-6 in mice, and immunohistochemical analyses showed that intramuscular lactate and hyaluronidase injections led to release of IL-6-containing intramyocellular vesicles. We identified a pool of IL-6 located within vesicles of skeletal muscle fibers, which could be readily secreted upon protease activity. This protease-dependent release of IL-6 was initiated by lactate production, linking training intensity and lactate production to IL-6 release during strenuous exercise.

Evaluation of the efficacy of epiduroscopic adhesiolysis in failed back surgery syndrome

Background/aim We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing treatment protocol. Materials and methodsEighty-two patients with FBSS symptoms were included. Two groups were composed as group I (stabilized) and group II (nonstabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the patient satisfaction scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. ResultsMean VAS scores were 7.8 and 3.28 points in group I (P < 0.001) and 7.51 and 2.74 points in group II (P < 0.001) at the beginning and at 12 months, respectively. Mean ODI scores were 34.05 and 22.16 points in group I (P < 0.001) and 30.74 and 19.46 points in group II (P < 0.001) at the beginning and at 12 months. VAS and ODI scores decreased significantly in both groups, but were more significant in the nonstabilized group (P < 0.001). Moderate or severe fibrous tissue was observed in 86.58% of the patients and patient satisfaction scores were very good or good in 78.06% of the patients. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the nonstabilization group; however, none of these patients developed a spinal headache and no significant permanent complication arose. ConclusionWe suggest that epidural adhesiolysis, hyaluronidase, and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis, and the possible course of the present findings and may be more effective in nonstabilized patients.

Role of Retrobulbar Hyaluronidase in Filler-Associated Blindness: Evaluation of Fundus Perfusion and Electroretinogram Readings in an Animal Model.

Hyaluronic acid gel filler-associated blindness is an uncommon but devastating complication. Hyaluronidase can potentially dissolve intravascular filler and improve perfusion; however, its role in filler-associated blindness has yet to be determined. The purpose of this study is to determine the effect of retrobulbar hyaluronidase on hyaluronic acid gel-induced ophthalmic artery occlusion in a rabbit model. New Zealand red rabbits were used to simulate hyaluronic acid gel filler-associated vascular occlusive blindness. Ophthalmic artery occlusion and subsequent ischemia were confirmed by both retinal fundus photography and electroretinogram changes. Retrobulbar hyaluronidase 1,000 IU was injected 30 minutes after occlusion. Fundus photography and electroretinogram changes were recorded at 30, 60, 90, and 120 after administration of retrobulbar hyaluronidase. A total of 6 rabbits were used, for a total of 12 eyes. Four eyes were used as controls. Of the 8 experimental eyes, 2 eyes had recorded partial occlusion and 6 eyes had fully occluded ophthalmic arteries by angiographic evaluation. One of the partially occluded eyes demonstrated some improvement in perfusion 60 minutes after injection of retrobulbar hyaluronidase; however, electroretinogram readings remained flat over the 120-minute period of observation. Six eyes with completely occluded ophthalmic arteries showed no improvement in retinal perfusion with corresponding flat electroretinogram readings at 120 minutes following retrobulbar hyaluronidase injection. In this rabbit model, 1,000 IU of retrobulbar hyaluronidase administered 30 minutes after occlusion failed to reverse obstruction or restore function following hyaluronic acid gel occlusion of the ophthalmic artery.

Late hyaluronidase injection in local anesthesia: Morphofunctional evaluation in rat sciatic nerve block.

Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL's vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation-associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID-induced block. Moreover, this protocol prolongs LID's anesthetic effect.

The study of short-term efficacy of intralesional injection of combination of triamcinalone, hyaluronidase and mitomycin in Peyronies disease

Background: Peyronies disease (PD) is physiologically and psychologically devastating disorder that is manifest by a fibrous inelastic scar of tunica albugenia resulting in palpable penile scar and deformity. Different modalities of nonsurgical treatment options exist without promising results in the long-term improvements of symptoms. The injection of pharmacologically active agents directly in to the penile plaque results in localized delivery and higher drug concentrations inside the plaque. With this rationale the study is planned to analyze the effectiveness of intralesional injection of triamcinalone, hyaluronidase, and mitomycin in the treatment of PD.Methods: Patients with symptomatic PD presenting at PGIMER from 1st July 2013 to 30th September 2014 were included in the study after obtaining the informed consent. A freshly prepared solution of a mixture of Triamcinalone, Hyaluronidase and Mitomycin was injected at the periphery as well as in the plaque. The patients were followed up for every four weeks for three months for the improvement of symptoms.Results: A total of 21 patients of symptomatic Peyronies disease with mean age of 44.4 and mean duration of 5.6 months were treated and followed up at PGIMER during July 2012 to September 30th, 2014. After completion of 3 months of treatment, 15/21 patients showed improvement in penile curvature. The overall response rate was 71.4% (p=0.001). 14/21 patients showed improvement in plaque size. The overall response rate was 66.66 (p=0.036). The IIEF-15 and PROSB score improved significantly both at 1st and 3rd month of follow up from the baseline score.Conclusions: This pilot study showed that the intralesional injection therapy is safe, well tolerated and effective in reducing the plaque size, penile curvature, and erectile dysfunction and patient’s bothersome score.

Point-of-Care Ultrasound Use in Neonatal Peripheral Intravenous Extravasation Injuries: A Case Series.

The primary aim of this study was to examine and describe peripheral intravenous extravasation (PIVE) injuries using point-of-care ultrasound (POC-US). A secondary aim was to define skin tissue changes before and after hyaluronidase application using POC-US. Case series design. We report on 10 neonates with stage 3 or 4 PIVE who were studied clinically and with POC-US. All infants were studied during the December 2015 to September 2016 period in a large academic neonatal intensive care unit. Initially, neonates with PIVE were staged using 3 criteria: physical findings, nature of the infusate, and the size of the injury. Next, we described different ultrasound appearances of the tissue injury in PIVE based on the type of the infusate (clear fluid, blood, or both). We then located the largest PIVE pocket and measured the skin elevation over it. Skin elevation ratio was measured at 3 time points: before hyaluronidase injection followed by 3 to 6 hours and 24 hours after hyaluronidase therapy. Each ultrasound examination of the skin injury was staged (severe, moderate, mild, or minimal) based on the skin elevation ratio obtained. In addition, we described changes in the skin using ultrasound before and after hyaluronidase treatment. Three types of ultrasound images based on the type of the extravasated fluid were described in detail. Based on the initial ultrasound measurements of the skin elevation ratio, 6 infants were staged with severe PIVE and 4 were staged as moderate PIVE. Finally, POC-US was used to describe the tissue changes before and after hyaluronidase injection. Point-of-care ultrasound may offer more structured and objective staging of PIVE injuries due to direct visualization of the skin tissue. This method needs to be further studied and introduced as a practical tool to complement physical examination of PIVE injuries.

Comparative Study of Intralesional Dexamethasone Plus Hyaluronidase &amp; Oral Colchicine in Patients with Oral Submucous Fibrosis

Introduction: Oral Submucous Fibrosis (OSMF) is a precancerous condition of the oral mucosa. It is characterized by excessive production of collagen leading to inelasticity of the oral mucosa and atrophic changes of the epithelium.Aim and objective: To evaluate the efficacy of oral Colchicine in comparison to intralesional injections of Dexamethasone plus Hyaluronidase in the management of OSMF patients.Materials and Methods: Fourty patients with OSMF were randomly divided equally into two groups. 20 patients in Dexamethasone group received biweekly intralesional injections of Dexamethasone (4mg/ml) plus Hyaluronidase 1500 IU in buccal mucosa for a period of 12 weeks. Other 20 patients in Colchicine group received oral Colchicine 0.5 mg tablets twice daily for 12 weeks. Parameters taken in the study were burning sensation, and mouth opening. Descriptive statistics, paired t test and unpaired t test were used for statistical analysis.Results and Conclusions: The pre- and post-treatment differences were found to be statistically significant for both the groups (p&lt;0.001) and for both the treatment outcomes. When the average difference of the treatment outcomes was compared between the two study groups, statistically highly significant difference was noted (p &lt;0.001) only in mouth opening but not in burning sensation.These encouraging results should prompt further clinical trials with Colchicine on a larger sample size to broaden the therapeutic usefulness of the drug in the management of OSMF. JNGMC, Vol. 14 No. 2 December 2016, Page: 60-65

Managing Periocular Filler-Related Syndrome Prior to Lower Blepharoplasty.

Hyaluronic acid (HA) fillers are extensively used in periocular volume augmentation. Although they have an excellent safety profile, filler-related issues such as visibility/palpability, contour abnormalities, malar edema, and blue-gray dyschromia can occur. Recognition and management of filler-related issues are critical prior to subsequent procedures. The clinical course of patients who had periocular HA filler-related issues and subsequently underwent lower eyelid blepharoplasty is described. HA filler was dissolved with hyaluronidase (15-30 U/cm2) treatment. Visible lower eyelid fat prolapse after filler removal was corrected with transconjunctival blepharoplasty with fat repositioning and skin resurfacing. Complications and outcome were assessed and recorded. Twenty-three patients (46 eyelids) were treated. All presented with contour abnormalities, 19 with contour abnormalities and malar edema, and seven with blue-gray dyschromia. In 15 patients, one session of hyaluronidase completely dissolved the filler, and in eight patients, two sessions were required. Of these eight patients, edema resolved after the second hyaluronidase injection in four; in the remaining four, mild edema persisted despite absence of visible/palpable filler. Postblepharoplasty, 19 patients had an acceptable outcome with no complications (82.6%). Four patients had prolonged edema postoperatively; three had a resolution by 6 months. In 23 patients who had skin resurfacing procedures, there was no incidence of postinflammatory hyperpigmentation. HA filler-related issues need to be identified and managed prior to further intervention. Hyaluronidase treatment effectively dissolves the filler, but mild malar edema can persist. Outcomes are acceptable after subsequent blepharoplasty, but adequate patient counseling is necessary about expectations and limitations. 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 .

Effect of Cosmetic Procedures in the Periorbital Area on the Organ of Vision: Overview

Practitioners in ophthalmology in recent years often face the effects of cosmetic procedures on the paraorbital area, as well as directly on the eyelids. Such influences include botox injections in paraorbital area, blepharoplasty, eyelash extensions, injections of various fillers, etc. These manipulations are widely used and often lead to various complications of the vision organ. Eyelash extensions are a popular procedure, especially among urban, young women, but there are potential health risks from the procedure. Tattooing of eyelids leads is the cause of dysfunction of meibomian glands, which can lead to the dry eye syndrome, manifested as complaints about a feeling of chronic discomfort in the eyes. Due to the growing popularity of the age tattoo, it is necessary to pay close attention to the training of specialists who conduct this procedure. The procedure for permanent eyelid make-up should be performed after careful consideration of possible complications, and by special trained professionals. In recent years, various cosmetic procedures for rejuvenating the face plays great role, for example, injections of botulinum toxin, as well as various dermal fillers — the application of which is aimed at eliminating the aging signs. The qualification of the specialist his awareness of the occurrence of possible complications, as well as the awareness of patients who undergo this procedure is an important aspect in the application of botulinum toxin, both for therapeutic and cosmetic purposes. Of great interest are the complications associated with ischemia in the form of soft tissue necrosis and vascular occlusion caused by fillers introduction. It is reported that the frequency of vascular occlusion with dermal fillers is up to 3 per 1000 injections. The only proven elimination of soft tissue ischemia in case of a hyaluronic acid filler use is early high-dose hyaluronidase injections, since this drug helps deactivate the action of hyaluronic acid. Modern ophthalmologic practice is inextricably linked with the latest methods of modern cosmetology medicine, the results of it can effect on the functions of the whole organism as the organ of vision in particular. This fact and the specificity of possible complications arising from cosmetic procedures in the periorbital zone should be taken into account during the anamnesis collecting anamnesis, and examining patients, including preoperative preparation, and in choosing the treatment method.

Human recombinant hyaluronidase injections for upper limb muscle stiffness in individuals with cerebral injury: A case series

Introduction: Spasticity, muscle stiffness, and contracture cause severe disability after central nervous system injury. However, current treatment options for spasticity produce muscle weakness which can impede movement and do not directly address muscle stiffness. Here we propose that the accumulation of hyaluronan within muscles promotes the development of muscle stiffness and report that treatment with the enzyme hyaluronidase increases upper limb movement and reduces muscle stiffness without producing weakness.

Treatment of post-traumatic hematoma and fibrosis using hyaluronidase injection.

Patients complaining of swelling and hematoma caused by contusion of the face can be easily seen in the emergency room. Most of the treatments were conservative treatments such as ice bag application, mild compression dressing, and massage. During the follow-up, fibrosis progression due to hematoma was frequently observed in the contusion site. When hematoma or fibrosis is confirmed, hyaluronidase (H-lase) 1,500 IU and 2 mL of normal saline were mixed and subcutaneously injected in crisscross manner. To evaluate the improvement of hematoma before and after hyaluronidase injection, three plastic surgeons evaluated using the Vancouver scar scale and compared preoperative and postoperative images. Hematoma and fibrosis after facial trauma improved after hyaluronidase injection for early treatment.

Glabella impending skin necrosis: a case report

A 47-year-old female patient undergoing hyaluronic acid injection in the glabella region suffered intravascular injection leading to marked discoloration (whitening) of the whole angiosome of the supratrochlear artery, extending to the areas of the anastomoses to the left upper eyelid, the dorsum of the nose, and the left sidewall of the nose. The syringe was immediately withdrawn while aspirating and prompt salvage counter-measures were taken, including application of warm compresses, vigorous massaging, oral administration of aspirin, repeated injections of hyaluronidase, and application of nitroglycerine paste on the affected area. The patient was followed up on a daily basis and the only additional treatment was the application of a combined antibiotic/steroid cream. The area affected healed satisfactorily with no scarring after 20 days. Our treatment protocol is discussed with special mention to the emerging role of hyaluronidase as the single most important rescue measure in the treatment of hyaluronic acid filler-related vascular adverse events. Level of Evidence: Level V, therapeutic study

Is hyaluronidase injection effective in treating tear trough hyaluronic acid filler deformity?

Is hyaluronidase injection effective in treating tear trough hyaluronic acid filler deformity?