In a study published in Plastic and Reconstructive Surgery (October 2015), researchers Zhong-Sheng Sun, MD, et al, retrospectively reviewed the clinical outcomes and the risk factors for facial skin ischemia/necrosis caused by hyaluronic acid filler injections. Using case-control analysis, they reviewed 20 consecutive patients who developed impending nasal skin necrosis as a primary concern after nose and/or nasolabial fold augmentation with HA fillers.
Seven patients (35%) developed full skin necrosis and 13 patients (65%) recovered fully after combination treatment with hyaluronidase. Both groups had similar age, sex, filler injection sites and complication treatment, yet 85% of subjects in the full skin necrosis group were late presenters who did not receive the combination treatment with hyaluronidase within two days after the vascular complication first appeared. In contrast, 15% of the patients in the full recovery group were late presenters (p = 0.004).
The researchers concluded that identifying and treating the ischemia as early as possible is key to keeping it from progressing to necrosis and that early (< two days) combination treatment with hyaluronidase is associated with full resolution of the complication.