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Dermal filler complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Hyaluronidase is an enzyme which dissolves hyaluronic acid, the key constituent in most dermal fillers. It needs to be injected directly into the area suspected of being devoid of arterial blood supply. A standard dose required for lysis of dermal fillers is 200 units. Some practitioners advocate mixing it with lidocaine or normal saline to increase the volume of solution and subsequently create a larger effective volume. Once administered, the area should be massaged and observed for one hour. If there is no improvement this may be repeated for three to four cycles. It is worth noting that approximately one in 1,000 people have an allergy to hyaluronidase, and subsequently, a skin test should be performed by injecting four units into the skin and observing for five minutes. Should a wheal appear in the skin then an allergy to hyaluronidase should be suspected. Even if no wheal is apparent, please be mindful that a life-threatening anaphylaxis could still occur after hyaluronidase hypodermolysis.
Complication management and prevention
Published in Jani van Loghem, Calcium Hydroxylapatite Soft Tissue Fillers, 2020
Pieter Siebenga, Jani van Loghem
Hyaluronidase should be injected in the area of vascular compromise, due to its edema-reducing properties [43,44]. The hyaluronidase may be injected directly into the affected site, with doses of 10–30U per 2 cm2 [44]. If no improvement (e.g., less blanching, improvement of capillary refill) is seen within 60 minutes, additional quantities of a hyaluronidase should be injected every two hours (repeat 3–4 cycles).
Complications of Fillers and Their Management
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Immediate blanching may be observed if the filler is inadvertently introduced intravascularly. Immediately treat the injection site with hyaluronidase. A dilution of 50–75 units/mL with either 1% lidocaine or normal saline is administered at a range of 0.1–1.0 mL. Inject throughout the affected region, but target the area of initial injection. If properly administered, reperfusion should be observed immediately. Pain is a symptom of vascular compromise. If there is a delay in diagnosis, a reticular pattern of red-to-violaceous hue will appear in the affected vascular tree. Injection of hyaluronidase is advised even days after the event. Unavailable in the US are heparinoid derivatives, which are also helpful in dissolving clots during the postocclusion phase. Topical nitroglycerin has been recommended to improve reperfusion, but has been debated. The clinical literature still supports its use.
The duration of hyaluronidase and optimal timing of hyaluronic acid (HA) filler reinjection after hyaluronidase injection
Published in Journal of Cosmetic and Laser Therapy, 2018
H. J. Kim, S. B. Kwon, K. U. Whang, J. S. Lee, Y. L. Park, S. Y. Lee
Hyaluronidase was developed as a spreading agent to promote the permeation and diffusion in connective tissue through the hydrolysis of HA. These enzymes have been approved for 3 purposes: (1) as an adjuvant to increase the absorption and dispersion of other injected drugs; (2) to produce hypodermoclysis; and (3) as an adjunct in subcutaneous urography for improving reabsorption of radiopaque agents (10). The use of hyaluronidase for correction of HA filler skin augmentation is an off-label application of its Food and Drug Administration (FDA)-approved indications. Hyaluronidases can be employed for eliminating nodules or bumps, for treating an overcorrection by HA filler injection and/or excessive superficial infiltrations. The modalities of hyaluronidase injection depend on the localization and quantity of the previous HA filler injection. Generally, 15–30 units of hyaluronidase is recommended for nasal, perioral skin, 30 units for periorbital area, and 10–15 units for infraorbital area (5,11,12). For the lower eye lid, 1.5 units is sufficient for correction (13).
New cyclopentaquinoline hybrids with multifunctional capacities for the treatment of Alzheimer’s disease
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2018
Kamila Czarnecka, Małgorzata Girek, Karolina Maciejewska, Robert Skibiński, Jakub Jończyk, Marek Bajda, Jacek Kabziński, Przemysław Sołowiej, Ireneusz Majsterek, Paweł Szymański
Inflammation is a complex biological response to aggressive agents (pathogens, injury), involving local vascular system and immune system. The inflammation is regulated by anti-inflammatory mediators, including cytokines, chemokines, and by several cellular enzymes, such as hyaluronidase. Hyaluronidase is an enzyme responsible for hyaluronan depolymerisation and by this process; it weakens the integrity of tissues during the inflammation. The prolonged inflammatory process is commonly associated with the development of some chronic disease, such as AD or cancers. Mostly for the treatment of inflammatory diseases, the non-steroidal anti-inflammatory (NSAIDs) are in common use. Due to the many side effects, such as gastrointestinal, renal, and cardiovascular toxicity, their use should be limited43. Therefore, novel drugs with anti-inflammatory properties are being investigated.
Effect of hyaluronidases added to different concentrations of bupivacaine on quality of ultrasound-guided supraclavicular brachial plexus block
Published in Egyptian Journal of Anaesthesia, 2021
Tarek Abdel Hay Mostafa, Alaa Mohammed Abo Hagar, Amany Faheem Abdel Salam Omara
Moreover, according to Adams, hyaluronidase has commonly used as an adjuvant in ophthalmic surgery to fasten the onset time of the ocular block and increase the success rate. [24] de Moura BD, et al. Meta-Analysis of Randomized Clinical Trials [25], which evaluated the efficacy of hyaluronidase in preventing total/partial failure of the regional block in ophthalmic surgery, was concluded that the efficacy of hyaluronidase associated with local anesthetics in preventing regional block failure in ophthalmic surgery. de Moura BD, et al. was similar to the results of this study by increasing the success rate of the regional block.