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Efficacy Of Hyaluronidase On Hyaluronic Acid And Non-Hyaluronic Acid Filler Induced Vascular Occlusion
Andrew L Kochuba MD, Sayf A Said MD, Majid Rezaei MD, Carlos Ordenana MD, and James E Zins MD FACS
Cleveland Clinic
2020-01-30
Presenter: Andrew Kochuba
Affidavit:
I agree
Director Name: Dr. James Zins
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
BACKGROUND: Inadvertent intravascular injection of hyaluronic acid filler is the presumed mechanism for both local soft tissue necrosis and visual impairment. Subcutaneous injection of hyaluronidase is the recommended treatment to reverse vascular occlusion and tissue ischemia. Few human studies have confirmed hyaluronidase's mechanism.
OBJECTIVES: To simulate the clinical scenario in cadaver model, confirm the mechanism of action of hyaluronidase, and document the effect of hyaluronidase on hyaluronic acid and non-hyaluronic acid vascular occlusion.
METHODS: Cadaver model was designed to resemble intravascular embolization of HA and non-HA filler. The angular arteries were ligated on both sides of the face and infiltrated with either HA or non-HA filler. Hyaluronidase at varying dosages and time intervals was injected on one side and saline on the opposite. 2x2cm specimens were dissected from each vessel to evaluate the efficacy of hyaluronidase on dissolving the filler by histological analysis.
RESULTS: Total of 20 cadaveric dissections are being performed. The baseline degradative effect of 500 units of Hyaluronidase on HA filler was confirmed but to varying degrees. Currently, the ideal dosing and time interval for hyaluronidase on HA filler occlusion as well as its efficacy of non-HA filler occlusion is being determined.
CONCLUSIONS: Although rare, intravascular injection of fillers can occur causing permanent damage. Hyaluronidase can potentially reverse the deleterious effects by enzymatically degrading the filler. Our study designed a cadaver model to resemble intravascular embolization of HA and non-HA fillers. Hyaluronidase reversed HA vascular occlusion. The ideal dose and injection interval is currently being determined.
