Delayed presentation of impending necrosis following soft tissue augmentation with hyaluronic acid and successful management with hyaluronidase.
Soft tissue augmentation is a key element in the successful management of facial rhytids and scars. Injection of hyaluronic acid gels into the dermis is generally well-tolerated with only minimal side effects. Injection necrosis is a rare but clinically significant side effect. We present a case of what appears to be slow swelling after injection of Juvederm (Allergan, Irvine, CA), which yielded delayed compression and vascular occlusion resulting in cutaneous necrosis. Such vascular compromise can present as delayed rather than immediately upon injection as would be the case with similarly reported cases of intra-arterial injection.
Hirsch
Ranella J
RJ
Section of Dermatology, Department of Medicine, Tulane Health Sciences Center, New Orleans, LA, USA.
Lupo
Mary
M
Cohen
Joel L
JL
Duffy
David
D
D000287:Administration, Topical; D000328:Adult; D003357:Cosmetic Techniques / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D009336:Necrosis / Q000473:pathology / Q000517:prevention & control*; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use; D015595:Skin Aging / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D014665:Vasodilator Agents; D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase; D005996:Nitroglycerin