Intralesional hyaluronidase injection to relieve non-hyaluronic acid filler-induced vascular adverse events.
calcium hydroxylapatite
hyaluronidase
lanluma
polylactic acid
radiesse
vascular adverse event
Journal
International journal of dermatology
ISSN: 1365-4632
Titre abrégé: Int J Dermatol
Pays: England
ID NLM: 0243704
Informations de publication
Date de publication:
02 Jul 2024
02 Jul 2024
Historique:
revised:
10
06
2024
received:
14
05
2024
accepted:
13
06
2024
medline:
3
7
2024
pubmed:
3
7
2024
entrez:
2
7
2024
Statut:
aheadofprint
Résumé
Vascular adverse events (VAEs) occurring during injections of soft-tissue fillers are still considered a challenging issue for both patients and practitioners. Hyaluronidase can dissolve hyaluronic acid (HA)-based soft-tissue fillers during a VAE. For VAEs induced by non-HA fillers, the absence of an "antidote" is regarded as exceptionally challenging. This multicenter study describes a case series of three VAEs induced by non-HA fillers, for which ultrasound-guided hyaluronidase injections were incorporated into the treatment approach. Two cases of calcium hydroxylapatite and one case of poly-L-lactic acid-induced VAEs are described, all of which were resolved without necrosis or scarring using a treatment approach with ultrasound-guided hyaluronidase injections. Unlike the mechanical hypothesis, which assumes filler particles travel antegrade to block arterioles in a large skin area, we hypothesize vasoconstriction as the pivot in VAEs. Filler injection-induced spasms could lead to long-lasting vasoconstriction of the perforator arteries stemming from the central facial arteries. Our results underscore that perforasome vasoconstriction might be the leading cause of the ischemia and subsequent necrosis in VAEs and that relaxation of these perforasomes, rather than dissolving the filler material, resolves the clinical symptoms associated with VAEs.
Sections du résumé
BACKGROUND
BACKGROUND
Vascular adverse events (VAEs) occurring during injections of soft-tissue fillers are still considered a challenging issue for both patients and practitioners. Hyaluronidase can dissolve hyaluronic acid (HA)-based soft-tissue fillers during a VAE. For VAEs induced by non-HA fillers, the absence of an "antidote" is regarded as exceptionally challenging.
METHODS
METHODS
This multicenter study describes a case series of three VAEs induced by non-HA fillers, for which ultrasound-guided hyaluronidase injections were incorporated into the treatment approach.
RESULTS
RESULTS
Two cases of calcium hydroxylapatite and one case of poly-L-lactic acid-induced VAEs are described, all of which were resolved without necrosis or scarring using a treatment approach with ultrasound-guided hyaluronidase injections.
CONCLUSIONS
CONCLUSIONS
Unlike the mechanical hypothesis, which assumes filler particles travel antegrade to block arterioles in a large skin area, we hypothesize vasoconstriction as the pivot in VAEs. Filler injection-induced spasms could lead to long-lasting vasoconstriction of the perforator arteries stemming from the central facial arteries. Our results underscore that perforasome vasoconstriction might be the leading cause of the ischemia and subsequent necrosis in VAEs and that relaxation of these perforasomes, rather than dissolving the filler material, resolves the clinical symptoms associated with VAEs.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 the International Society of Dermatology.
Références
Schelke LW, Velthuis P, Decates T, Kadouch J, et al. Ultrasound‐guided targeted vs regional flooding: a comparative study for improving the clinical outcome in soft tissue filler vascular adverse event management. Aesthet Surg J. 2023;43(1):86–96.
DeLorenzi C. New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J. 2017;37:814–825.
Schelke LW, Velthuis P, Kadouch J, Swift A. Early ultrasound for diagnosis and treatment of vascular adverse events with hyaluronic acid fillers. J Am Acad Dermatol. 2023;88:79–85.
Taylor GI, Palmer JH. Angiosome theory. Br J Plast Surg. 1992;45(4):327–328.
Ashton MW, Taylor GI, Corlett RJ. The role of anastomotic vessels in controlling tissue viability and defining tissue necrosis with special reference to complications following injection of hyaluronic acid fillers. Plast Reconstr Surg. 2018;141(6):818e–830e.
Schelke LW, Velthuis PJ, Mojallal A, Henry G, et al. Reticulated livedoid skin patterns after soft‐tissue filler‐related vascular adverse events. J Am Acad Dermatol. 2024;91(1):37–42.
Robinson DM. In vitro analysis of the degradation of calcium hydroxylapatite dermal filler: a proof‐of‐concept study. Dermatologic Surg. 2018;44(Suppl 1):S5–S9.
Sharma SC, Lahiri A. Use of hyaluronidase in plastic surgery: a review. J Plast Reconstr Aesthet Surg. 2021;74(7):1610–1614.
van Loghem J, Funt D, Pavicic T, Goldie K, Yutskovskaya Y, Fabi S, et al. Managing intravascular complications following treatment with calcium hydroxylapatite: an expert consensus. J Cosmet Dermatol. 2020;19(11):2845–2858.
Yankova M, Pavicic T, Frank K, Schenck TL, Beleznay K, Gavril DL, et al. Intraarterial degradation of calcium hydroxylapatite using sodium thiosulfate – an in vitro and cadaveric study. Aesthet Surg J. 2021;41(5):NP226–NP236.
Schelke LW, Cassuto D, Velthuis P, Wortsman X. Nomenclature proposal for the sonographic description and reporting of soft tissue fillers. J Cosmet Dermatol. 2020;19(2):282–288.
Saint‐Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 2009;124(5):1529–1544.
McConnell ED, Wei HS, Reitz KM, Kang H, Takano T, Vates GE, et al. Cerebral microcirculatory failure after subarachnoid hemorrhage is reversed by hyaluronidase. J Cereb Blood Flow Metab. 2016;36(9):1537–1552.