Tagaya Manaka, Arai Konyo, Kapoor Krishan Mohan
From the La Belle Mira Clinic, Nagoya, Japan.
Anticlock Clinic, Chandigarh, India.
Plast Reconstr Surg Glob Open. 2025 Sep 10;13(9):e7087. doi: 10.1097/GOX.0000000000007087. eCollection 2025 Sep.
Vascular complications following hyaluronic acid filler injections are rare but may lead to ischemia and necrosis. Effective management often relies on the early administration of hyaluronidase to restore perfusion and prevent long-term damage. However, delayed presentations pose unique challenges due to prolonged ischemia and increased risk of tissue necrosis. A 35-year-old woman presented 3 days after forehead filler injection with signs of vascular compromise. Initial treatment with 1800 U hyaluronidase failed. On presentation, she exhibited advanced ischemia with erythema, pustules, and livedo reticularis. A high-dose pulsed hyaluronidase protocol totaling 32,000 U for 4 days was initiated. Rapid improvement followed, with complete epithelialization by day 30 and near-complete recovery by day 90 without scarring. Despite delayed presentation, the high-dose pulsed hyaluronidase protocol successfully reversed ischemia and prevented necrosis, supporting its use in late-stage vascular complications.
透明质酸填充剂注射后的血管并发症虽罕见，但可能导致缺血和坏死。有效的处理通常依赖于早期注射透明质酸酶以恢复灌注并防止长期损害。然而，由于缺血时间延长和组织坏死风险增加，延迟就诊带来了独特的挑战。一名35岁女性在额头填充剂注射3天后出现血管受损迹象。最初注射1800 U透明质酸酶治疗失败。就诊时，她表现出严重缺血，伴有红斑、脓疱和网状青斑。启动了为期4天、总量达32000 U的高剂量脉冲透明质酸酶方案。随后病情迅速改善，第30天完全上皮化，第90天几乎完全恢复且无瘢痕形成。尽管就诊延迟，但高剂量脉冲透明质酸酶方案成功逆转了缺血并防止了坏死，支持其在晚期血管并发症中的应用。
