When managing acute vascular compromise secondary to hyaluronic acid filler, what initial hyaluronidase dosing protocol do you employ, and do you find clinical value in traditional adjuncts like aspirin, nitroglycerin paste, or hyperbaric oxygen?

Whether it is acute vascular compromise due to cannulating the vessel, it is now believed best to flood the area with hyaluronidase. I have 6 vials of Hylenex and 2 vials of Vitrase in my fridge at all times in case of emergency. Usually, if you are performing hyaluronic fillers, going slow and observing the treatment area and patient response should catch a vascular compromise earlier, but if you notice changes after completion of filler injections, then I typically recommend using an entire bo...

Great overview, Dr. @Dr. First Last. Our emphasis is heavily focused on high-dose flooding with hyaluronidase products across the affected area to rapidly dissolve intra-arterial emboli and relieve extravascular compression.

In our protocol, we infiltrate high-dose hyaluronidase throughout the entire compromised vascular territory, then re-evaluate every 30 to 60 minutes. We closely monitor for the resolution of livedo patterns, reduction in ischemic pain, and normalization of capillary refill. ...