title: Delayed presentation of impending necrosis following soft tissue augmentation with hyaluronic acid and successful management with hyaluronidase.
abstract: 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.
authors: Section of Dermatology, Department of Medicine, Tulane Health Sciences Center, New Orleans, LA, USA.
authors: Ranella J
authors: RJ
authors: Hirsch
authors: Mary
authors: M
authors: Lupo
authors: Joel L
authors: JL
authors: Cohen
authors: David
authors: D
authors: Duffy
mesh_terms: 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
chemical_list: D014665:Vasodilator Agents; D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase; D005996:Nitroglycerin