Physicians in Singapore were able to reverse ischemic skin necrosis caused by intra-arterial filler injection by using a high-dose pulsed regimen with hyaluronidase. In the case study, published in Plastic and Reconstructive Surgery—Global Open (February 2018), a 50-year-old woman received treatment with a hyaluronic acid filler to both sides of her face. Skin blanching in the right malar area, which did not improve following application of heat packs, appeared 15 minutes after injection and 25 minutes later a reticular pattern was observed on the right side of her face extending from the radix of the nose to the right cheek.
The patient was treated promptly with three 1,000-unit pulses of hyaluronidase, administered hourly to all involved areas with a 1 cm overlap in uninvolved, bordering skin areas. After the first dose, there was no further increase in size of the involved area. After the third treatment, the endpoint of complete reperfusion and good capillary filling were achieved. By three weeks post-treatment, the skin was fully recovered.
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