Qiang Shuai, Fan Xing, Yin Yue, Xue Ping, Dou Wen-Jie, Li Tong, Yang Qing
Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, Xi'an, Shaanxi, China.
J Cosmet Dermatol. 2025 Jul;24(7):e70294. doi: 10.1111/jocd.70294.
Hyaluronic acid (HA) fillers are popular for their minimally invasive nature and immediate aesthetic outcomes, but vascular compromise remains a significant complication. This study investigates optimized therapeutic strategies to prevent tissue necrosis following HA filler injections.
To evaluate the efficacy of two treatment regimens for managing impending nasal skin necrosis due to HA filler injections, focusing on preventing tissue necrosis and reducing complications such as pigmentation changes, scarring, and telangiectasia.
A retrospective analysis was conducted on 41 female patients (mean age: 36.2 years) treated at a single referral center between 2018 and 2023. Patients presented within 72 h after developing ischemic symptoms following HA injections for nasal augmentation. Two treatment regimens, both integrating hyperbaric oxygen therapy (HBOT), epidermal growth factor (EGF) gel, and corticosteroids, were evaluated: one using nitroglycerin (NTG) and the other using isosorbide dinitrate (ISDN).
All patients achieved complete wound healing, with no significant differences in scar formation or hypotension between the treatment groups (p > 0.05). Hyaluronidase (HSE) was administered externally at referring clinics prior to hospital admission in 31.7% of patients (without subsequent standardized HSE protocol), significantly reducing telangiectasia incidence (p < 0.05) but not affecting scarring or pigmentation (p > 0.05). Early hospital presentation (< 48 h) was associated with lower pigmentation changes (p < 0.05) but did not significantly affect scarring. Residual complications included scar formation in 9 of 41 patients (21.9%, 95% CI 12.0-36.7), telangiectasia in 16 of 41 (39.0%, 95% CI 25.7-54.3), and pigmentation changes in 22 of 41 (53.7%, 95% CI 38.7-67.9).
Combined therapies effectively manage HA-induced vascular compromise, with early intervention critical for reducing ischemic complications and improving patient outcomes.
透明质酸（HA）填充剂因其微创性和即时美学效果而广受欢迎，但血管损伤仍是一个重大并发症。本研究探讨优化的治疗策略，以预防HA填充剂注射后组织坏死。
评估两种治疗方案对HA填充剂注射所致即将发生的鼻皮肤坏死的治疗效果，重点是预防组织坏死并减少色素沉着改变、瘢痕形成和毛细血管扩张等并发症。
对2018年至2023年在单一转诊中心接受治疗的41例女性患者（平均年龄：36.2岁）进行回顾性分析。患者在接受HA注射隆鼻后出现缺血症状的72小时内就诊。评估了两种均整合了高压氧治疗（HBOT）、表皮生长因子（EGF）凝胶和皮质类固醇的治疗方案：一种使用硝酸甘油（NTG），另一种使用异山梨醇二硝酸酯（ISDN）。
所有患者均实现伤口完全愈合，治疗组之间在瘢痕形成或低血压方面无显著差异（p>0.05）。31.7%的患者在入院前在转诊诊所接受了外用透明质酸酶（HSE）治疗（无后续标准化HSE方案），这显著降低了毛细血管扩张的发生率（p<0.05），但不影响瘢痕形成或色素沉着（p>0.05）。早期入院（<48小时）与较低的色素沉着改变相关（p<0.05），但对瘢痕形成无显著影响。残余并发症包括41例患者中的9例出现瘢痕形成（21.9%，95%CI 12.0-36.7），41例中的16例出现毛细血管扩张（39.0%，95%CI 25.7-54.3），41例中的22例出现色素沉着改变（53.7%，95%CI 38.7-67.9）。
联合治疗可有效处理HA引起的血管损伤，早期干预对于减少缺血性并发症和改善患者预后至关重要。
