Efficacy of Percutaneous Intraarterial Facial/Supratrochlear Arterial Hyaluronidase Injection for Treatment of Vascular Embolism Resulting From Hyaluronic Acid Filler Cosmetic Injection

Background Vascular embolism is a serious complication of hyaluronic acid (HA) filler cosmetic injection and hyaluronidase injection has been proposed as the treatment. Until now there is a lack of adequate clinical evidence regarding the benefits of treatment for HA filler-induced vascular embolism by percutaneous facial or supratrochlear arterial hyaluronidase injection. Objectives To evaluate the efficacy of percutaneous facial or supratrochlear arterial hyaluronidase injection as a rescue treatment for HA filler-induced vascular embolism. Methods We included 17 patients with vascular embolism after facial HA filler injection. Intraarterial injection of 1500 units hyaluronidase was performed via facial artery for thirteen cases with skin necrosis and via supratrochlear arterial for four cases with severe ptosis and skin necrosis but no visual impairment. Simultaneously, the general symptomatic treatment and nutritional therapy were performed. Results After hyaluronidase injection, the facial skin necrosis in all cases was restored and the ptosis in the four cases was also significantly relieved. Patients were subsequently followed for 1 month to 1 year. The skin necrosis in 16 patients were completely healed and only 1 patient had small, superficial scars. Conclusions It is effective to alleviate the skin necrosis and ptosis resulting from HA filler embolism via percutaneous facial or supratrochlear arterial hyaluronidase injection.