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Background: Vascular adverse events (VAEs) occurring during injections of soft‐tissue fillers are still considered a challenging issue for both patients and practitioners. Hyaluronidase can dissolve hyaluronic acid (HA)‐based soft‐tissue fillers during a VAE. For VAEs induced by non‐HA fillers, the absence of an "antidote" is regarded as exceptionally challenging. Methods: This multicenter study describes a case series of three VAEs induced by non‐HA fillers, for which ultrasound‐guided hyaluronidase injections were incorporated into the treatment approach. Results: Two cases of calcium hydroxylapatite and one case of poly‐L‐lactic acid‐induced VAEs are described, all of which were resolved without necrosis or scarring using a treatment approach with ultrasound‐guided hyaluronidase injections. Conclusions: Unlike the mechanical hypothesis, which assumes filler particles travel antegrade to block arterioles in a large skin area, we hypothesize vasoconstriction as the pivot in VAEs. Filler injection‐induced spasms could lead to long‐lasting vasoconstriction of the perforator arteries stemming from the central facial arteries. Our results underscore that perforasome vasoconstriction might be the leading cause of the ischemia and subsequent necrosis in VAEs and that relaxation of these perforasomes, rather than dissolving the filler material, resolves the clinical symptoms associated with VAEs. [ABSTRACT FROM AUTHOR]

Introduction: Hyaluronic acid (HA) is a safe and commonly used filler for soft tissue augmentation. However, some complications can occur, particularly if the technique of application is inadequate or the quality of the material is poor. Objective: To underline the importance of clinical examination in the era of rapid technological development. Case report: A 27-year-old woman presented to our clinic due to poor aesthetic results after multiple lip augmentation using hyaluronic acid injections followed by an unsuccessful treatment in a different medical centre in which she was overdiagnosed. The patient underwent several hyaluronidase injections and an ultrasound-guided core biopsy. Hyaluronic acid was not found in any of the taken specimens. Next, surgical removal of the filler was proposed. We proposed hyaluronidase and antibiotic treatment that resulted in a satisfactory aesthetic effect. Conclusions: Additional tests can be useful in managing complications of hyaluronic acid procedures, but they should be correlated with clinical expertise. [ABSTRACT FROM AUTHOR]

Injectable dermal fillers continue to increase in popularity in aesthetic medicine. Although rare, vision loss secondary to filler injections is a devastating complication associated with a poor visual prognosis. The mechanism for vision loss is thought to be related to retrograde embolization of the dermal filler from peripheral vessels in the face into the ophthalmic arterial system. Early recognition and prompt management are essential if vision is to be salvaged. The use of retrobulbar hyaluronidase is still contentious, however when administered by a specialist, this treatment gives the best chance at visual recovery and should be considered for all cases. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to compare the effectiveness of intralesional placentrex versus hyaluronidase + dexamethasone injection in the symptomatic management of stage II OSMF. Materials and Methods: This was a non-randomized prospective study conducted over a period of 14 months at a tertiary referral center. Patients with clinical stage II OSMF were randomly grouped into A(n = 18) and B(n = 17). These patients were treated with weekly intralesional injection of placentrex and hyaluronidase + dexamethasone respectively, over a period of six weeks. Variables such as mouth opening, burning sensation and colour of mucosa were evaluated at baseline(T0), second week(T1), fourth week(T3), sixth week(T4) of follow up. A p-value < 0.05 was considered statistically significant. Results: A total of 15 patients completed the study in each group with regular follow up. The mean improvement in mouth opening was 4.3 ± 0.57 mms in group A(p-value < 0.001) and 7.2 ± 0.76 mms in group B(p-value < 0.001) which were significant at the end of six weeks. Mean change in burning sensation at the end of six weeks in group A was 1.2 ± 0.73(p-value < 0.001), and 3.6 ± 0.63(p-value < 0.001) in group B. Mean change in colour of mucosa at the end of six weeks was 1.4 in group A(p-value > 0.05) and 2 in group B(p-value > 0.05). On comparison between both groups, patients in group B exhibited better mouth opening and reduction of burning sensation than patients in group A(p-value < 0.001). Conclusion: Both intralesional placentrex and hyaluronidase + dexamethasone injection are effective in alleviating the symptoms of stage II OSMF. However, hyaluronidase + dexamethasone injection showed slightly better improvement in mouth opening and burning sensation after six weeks. [ABSTRACT FROM AUTHOR]

This study aimed to compare the results of injection triamcinolone and hyaluronidase combination with injection Platelet Rich Plasma (PRP) in management of Oral Submucous Fibrosis (OSMF). Present study was carried out in randomly divided two groups of 30 patients each of OSMF who all are presented with chief complain of reduced mouth opening. Group A patients were given 1 ml of injection triamcinolone and hyaluronidase combination. Group B patients received 1 ml of injection Platelet Rich Plasma. Both injections were given intralesionally once a week for 6 weeks. Results of ANOVA shows significant better results in improving mouth opening in group B patients receiving injection Platelet Rich Plasma as a treatment. In Group A, patients shows improvement in Maximum interincisal distance (MIID) of mean 6.51 ± 1.02 mm as compared to the patients in group B shows improvement in MIID of mean 9.53 ± 1.06 mm (p value < 0.05). Treatment of OSMF with injection Platelet Rich Plasma is a novel method and found to be more efficient than treatment with injection triamcinolone and hyaluronidase combination. [ABSTRACT FROM AUTHOR]

Background: Peribulbar anesthesia had been developed as a safer, easier, and effective alternative to retrobulbar anesthesia that provides ocular akinesia and anesthesia. Objective: This study aimed to compare the efficacy of mepivacaine 3% - lidocaine 2% hyaluronidase mixture with that of bupivacaine 0.5% - lidocaine 2% - hyaluronidase to produce optimal operative and post-operative conditions in patients receiving single peribulbar injection for cataract surgery. Patients and Methods: In this randomized, double -blind study, 90 adult patients were assigned to one of two groups (M and B), each comprising 45 patients. Study participants received 6-8 ml combination of equal parts of either mepivacaine 3% (Group M) or bupivacaine 0.5% (Group B) both with lidocaine 2% and hyaluronidase 25 IU/ml. Akinesia was assessed with a 12-point scale at 2, 5, 10 and 15 min after injection. Onset of sensory block, time to start surgery, pain and requirement for supplemental injection were also assessed. Results: Group M showed better akinesia scores than Group B and the onset of globe akinesia and sensory block were significantly faster in Group M. The duration of globe and lid akinesia was longer in Group B (159.16 ± 5.71 min and 150.02 ± 4.42 min, respectively) than in Group M (142.89 ± 6.52 min and 135.69 ± 4.81 min, respectively) and this showed statistical significance (P < 0.001). The percentage of patients who required supplementary injection was significantly higher in Group B (7 patients) compared to that in Group M (2 patients). Conclusion: Using a mixture of mepivacaine and lidocaine gives perfect globe akinesia and quicker establishment of appropriate conditions to start cataract surgery and shortens the block onset time with faster recovery compared with the addition of bupivacaine to lidocaine in peribulbar anesthesia. [ABSTRACT FROM AUTHOR]

This article discusses the use of botulinum neurotoxin (BoNT) injections in the mentalis muscle to treat a condition called cobblestone chin. The article highlights the potential risks and complications associated with this technique, including uneven drooping of the lower lip, impaired mouth opening, and paradoxical mentalis bulging. The spread of BoNT to adjacent muscles can also lead to uneven alterations in lower facial expressions. The article emphasizes the importance of precise injection techniques and anatomical considerations to minimize these adverse effects. Additionally, the article mentions the use of ultrasound examination to guide the injection of hyaluronidase for the dissolution of hyaluronic acid fillers. Overall, the article provides insights into the challenges and considerations involved in using BoNT injections for the mentalis muscle. [Extracted from the article]

Introduction: Scleromyxedema is a rare primary cutaneous mucinosis characterized by numerous firm, waxy, confluent papules. Recently, intravenous immunoglobulin (IVIG) is accepted by many authors as the first‐line treatment option for severe cases. We report a 69‐year‐old male patient who has been suffering from scleromyxedema, with reduced mouth opening. He has been on a high‐dose IVIG regime for 5 years. Methods: The patient stated that he had difficulty in wearing and removing his dentures because of reduced mouth opening lately. Before considering to add any other immunosuppressants to his regime, we injected 1500 IU of hyaluronidase in total in one session periorally. The patient has been told open his mouth maximum and photographs have been taken before injections and after one month. We used a photo measurement application when evaluating microstomia to increase accuracy. We also took punch biopsies in order to evaluate effect of hyaluronidase histopathologically before and one month after injections. Results: One month later, he was able to reattach and remove his dentures without adding any adjuvant immunosuppressants other than hyaluronidase. Mouth opening was increased in measurements and histopathologically, mucin deposition, fibroblastic proliferation, and perivascular lymphocytic infiltration were decreased. Conclusions: We think hyaluronidase is a safe, easily accessible, and effective treatment option for microstomia caused by scleromyxedema. [ABSTRACT FROM AUTHOR]

Background: Non-surgical nasal reshaping with hyaluronic acid filler is a well-established procedure performed in order to ameliorate nasal appearance and considered a valid alternative to surgical rhinoplasty in selected patients. The aim of this systematic review is to evaluate, in patients looking for surgical rhinoplasty who already received nSNR with HA, if hyaluronidase injection before surgery is to prefer instead of direct surgery in order to reduce/avoid intra-operative troubles in performing a rhinoplasty. Methods: The literature search was carried out on electronic PubMed and Cochrane Library databases identifying 567 articles up to May 19th, 2021. Number of patients, outcomes and complications were extracted. Results: Three retrospective articles were eligible for inclusion in the review. Thirteen patients were operated on for rhinoplasty who previously received nSNR with HA. Six received hyaluronidase injections before surgery and 7 underwent directly to surgery. Among the 7 who went straight to surgery, in 5 of them, 6 months was the specified time lapse between last HA injection and surgery. Among the ones receiving hyaluronidase injection before surgery, the time lapse reported was 6 months for 1 patient, 3 months for 2 patients, 2 months for 1 patient and 7 days for 1 patient. Post-operative complications were not recorded. Conclusions: Either direct surgical approach or hyaluronidase injection first seems to be a viable option with the total absence of post-operative complications. When direct surgery is preferred, it could be demanding and customized informed consent should be released to the patients prior to surgery. Level of evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Background: Data suggest that hyaluronic acid (HA) fillers using VYC technology have a higher incidence of delayed‐onset nodule development at facial injection sites than earlier HA products. Objective: To assess the incidence of delayed‐onset nodules with VYC products based on a single experienced injector. Methods and Materials: Patients with delayed‐onset nodules after injections with VYC‐20L, VYC‐17.5L, and VYC‐15L were identified by retrospective chart review. Results: Since 2010, 2139 patients received injections from the same physician with combinations of VYC‐20L (57.6% of patients; 2.4 syringes/patient), VYC‐17.5L (23.9%; 1.5), or VYC‐15L (18.5%; 1.5). Seven female patients (mean age, 62 years) developed delayed‐onset nodules for an overall incidence of 0.33%. A potential inflammatory trigger (reported by 6 patients) occurred 1–168 days prior to nodule development. Nodule biopsy in 1 patient confirmed a foreign‐body granuloma. The most effective treatment incorporated prednisone with or without hyaluronidase, and in 2 patients, nodules resolved spontaneously. The incidence of delayed‐onset nodules was not associated with injection technique or amount of product used. Conclusion: VYC‐associated incidence of delayed‐onset nodules (0.33%) was lower than earlier estimates from previous studies. In the current analysis, VYC‐15L had a rate of delayed reactions comparable with non‐VYC products. [ABSTRACT FROM AUTHOR]

Background: The aesthetic treatment based on fillers with hyaluronic acid presents an increasing demand in the present day because it is considered a safe and minimally invasive procedure. In the management of adverse effects or more severe complications of hyaluronic acid‐based fillers, hyaluronidase is the treatment of choice. Aims: To demonstrate efficacy in reversibility and safety in the treatment of HA complications. Patients/Methods: It is a retrospective study article that reports the use of hyaluronidase in the main undesirable effects of fillers in 114 patients in a private dermatological clinic from 2015 to 2018. Results: The target of the application was 51 cases of overcorrection (45%), 50 cases of Tyndall effect (44%), and 13 late nodules (11%). When we evaluated the areas where HYAL was injected, we found that the area with the most indication of the application of the product was the eyelid region (58 injections). Conclusion: This study concluded that HYAL is a safe and effective drug in the management of mild adverse events of HA applications with no severe side effects in our protocol of use. [ABSTRACT FROM AUTHOR]

Background: Recombinant human hyaluronidase PH20 (rHuPH20) facilitates the dispersion and absorption of subcutaneously administered therapeutic agents. This study aimed to characterize the transient, local action of rHuPH20 in the subcutaneous (SC) space using focused biodistribution and dye dispersion studies conducted in mice. Materials and methods: To evaluate the biodistribution of rHuPH20, mice were intradermally administered rHuPH20 (80 U). The enzymatic activity of rHuPH20 was analyzed in the skin, lymph nodes, and plasma. Animal model sensitivity was determined by intravenous administration of rHuPH20 (80 U) to the tail vein. To evaluate local dispersion, mice received an intradermal injection of rHuPH20 followed by an intradermal injection of Trypan Blue dye at a contralateral site 45 minutes later. Dye dispersion was measured using a digital caliper. Results: After intradermal rHuPH20 injection, enzymatic activity was detected within the skin near the injection site with levels decreasing rapidly after 15 minutes. There was no clear evidence of systemic exposure after administration of rHuPH20, and no discernible rHuPH20 activity was observed in lymph or plasma as a function of time after dosing. In the dye dispersion study, delivery of rHuPH20 at one site did not impact dye dispersion at a distal skin site. Conclusion: These observations support the classification of rHuPH20 as a transiently active and locally acting permeation enhancer. [ABSTRACT FROM AUTHOR]

This article discusses the degradation of hyaluronic acid (HA) fillers after the injection of hyaluronidase, an enzyme used to reverse the effects of HA fillers. The study compares the degradation of different HA fillers, including VYC-25L, using a rat model. The results show that all HA fillers tested were susceptible to degradation by hyaluronidase, with no significant differences in degradation rates among the fillers. The study suggests that the properties of HA fillers do not significantly impact their sensitivity to enzymatic degradation. However, the study acknowledges that further research is needed to understand the factors that affect the sensitivity of HA fillers to hyaluronidase in a clinical setting. [Extracted from the article]

This article discusses a rare but important complication that can occur following the injection of hyaluronic acid (HA) for osteoarthritis treatment. HA is commonly used in dermatology for skin augmentation and also provides lubrication for joints. In this case, a patient developed retiform purpura and skin necrosis after an inadvertent injection of HA into an artery in the knee. The patient was treated with hyaluronidase and other medications, and her symptoms improved. This case highlights the need for dermatologists to be aware of potential complications with HA injections and emphasizes the importance of understanding anatomy when performing these procedures. [Extracted from the article]

Purpose: Hyaluronic acid (HA) is the most common injectable dermal filler used for soft-tissue augmentation, and can be removed non-surgically by directly injecting hyaluronidase. In this study, the hyaluronidase-mediated degradation of different types of HA fillers implanted subcutaneously at the back of hairless mice having filler residence time of four days or three months were compared. Methods: Two sites at the back of female hairless mice were subcutaneously implanted with 0.1-mL of one of the seven HA fillers (NLL, NL, NDL, NVL, and ND, JUVX+, and RESLYFT) and injected with 30 IU or 60 IU hyaluronidase per 0.1-mL filler after reaching a filler residence time of 4 or 91 days, respectively. Filler bolus projection was measured using three-dimensional optical imaging over a 72 h period, and the implantation sites were histologically examined 2 weeks after hyaluronidase injection. Results: Following hyaluronidase injection, all seven HA fillers showed a rapid decrease of filler volume within 24 h, and complete degradation was confirmed by histological examination after 2 weeks. There was no significant difference in filler volume reduction rate among the seven HA fillers, and no evidence of macroscopic or microscopic adverse effects were observed at the implantation sites. Conclusion: All seven HA fillers show comparable susceptibility to hyaluronidase-mediated degradation. HA fillers with prolonged filler residence time may require a higher dose of hyaluronidase to achieve efficient degradation owing to tissue integration. [ABSTRACT FROM AUTHOR]

Delayed-onset nodules, a potential complication of injectable hyaluronic acid (HA) fillers, can be distressing to both patient and clinician. Current treatment options, including oral corticosteroids and antibiotics, have potential side effects and may be ineffective or contraindicated in some patients. Hyaluronidase is an enzyme used to degrade HA fillers. Although it is generally effective for resolving such nodules, it can interfere with the favorable aesthetic effects of filler treatment. This report describes a novel and successful method of treating delayed-onset nodules in facial tissue. Radial sound (shockwave) therapy was used to treat multiple delayed-onset facial nodules in two patients following HA filler injection. Substantial improvement was observed in both patients after the initial 10-minute session, and all nodules resolved fully by the third or fourth treatment. There were no side effects or downtime. Patients were satisfied with the results, particularly because the aesthetic effects of the HA filler were maintained. [ABSTRACT FROM AUTHOR]

Background: For patients who have back pain or radiating pain, lumbar intervention should be performed at the correct lumbar segment that triggers pain. It is quite common for pain physicians to identify lumbar segments based upon the 12th pair of ribs to do an interventional procedure. Case: We experienced two cases of rib number abnormality (absent 12th rib pair) that made the injection ineffective. In both cases, we had misidentified the lumbar segmentation due to rib abnormality. Although the procedure was performed properly, the clinical symptoms of the patient were not well correlated with the dermatome, and the diagnosis was delayed. Conclusions: These cases suggest that rib counting is necessary for more accurate lumbar segmentation. If the expected effect has not appeared after intervention, rib numbers should be checked. [ABSTRACT FROM AUTHOR]

Introduction: There has been renewed public and professional interest in the topic of cosmetic penile girth enhancement. Hyaluronic acid (HA) injections have been proposed as a safer alternative to surgical options, however limited data exist regarding efficacy. Objective: The purpose of our study was to evaluate average girth changes and related metrics in men undergoing penile girth enhancement with sequential administration of HA dermal filler at a single site. Methods: We performed a retrospective review of men who underwent penile girth enhancement with HA from May 17, 2022 to April 28, 2023. Results: 155 men underwent penile girth enhancement with HA filler and were instructed to follow a strict post-injection protocol. On average, men experienced a 0.633 cm increase in girth per treatment receiving an average of 12.5 total syringes over 2.2 treatments. Ultimately, all men receiving multiple treatments experienced an average girth increase of 1.8 cm as measured prior to their final treatment. 23 men who received 4 treatments or more experienced an average girth increase of 2.952 cm as measured prior to their final treatment. Of the 155 men treated, 19 (12.3%) required cosmetic correction with either hyaluronidase or abobotulinumtoxinA. Conclusions: Our study suggests that injection of HA dermal filler is an effective option for men desiring non-surgical penile girth enhancement. Further studies are needed to better characterize outcomes and optimal treatment protocols. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill. [ABSTRACT FROM AUTHOR]

Delayed inflammatory reactions (DIRs) associated with hyaluronic acid injections are not rare and can be seen in up to 4.25% of patients. Although the exact mechanism is not clear, several triggering factors, including infections, trauma, and dental procedures, were reported in the literature. A 43-year-old female patient treated with HA fillers developed an inflammatory reaction following vaccination in all areas of injection, including temples, lips, and lower eyelids. Systemic steroid and ciprofloxacin were used as a first-line treatment without response. Colchicine 1 mg/day along with hyaluronidase in lower eyelids improved all lesions successfully. [ABSTRACT FROM AUTHOR]

Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle. 1. Preop application of EMLA cream/AMITOP to the donor site 2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain. 3. Mark out the SSG donor site 4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound. 5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site. 6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. 7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hyaluronic acid (HA) filler injection is commonly used for soft tissue augmentation. Uncommon but serious complication from filler injection is vascular occlusion. Hyaluronidase enzyme can be used to dissolve HA filler. Evidence demonstrates that hyaluronidase can penetrate through vessel wall after incubation. However, studies regarding effects of hyaluronidase on vessel wall after intraluminal injection are limited. The objective of this study is to evaluate histological changes of postmortem arteries after intravascular injection of hyaluronidase enzyme. Methods: This was an ex vivo experiment including arterial specimens from four cadavers which recently deceased within 24 hours. All vessels were examined at baseline and then were divided into two groups. The first was the control group treated with normal saline and the second hyaluronidase‐treated group was intra‐luminally injected with hyaluronidase enzyme (1500 IU/mL). Gross and histological examination was performed at baseline, 30‐minutes and 4 hours after. Results: Gross examination of vessels revealed no significant difference at baseline, 30 minutes and 4 hours after injection in both groups. Histological examinations at baseline and 30 minutes after injection revealed viable endothelial cells in both experimental and NSS‐control group. At 4 hours after hyaluronidase injection, two of the four arterial specimens had degeneration of endothelial cell, and one artery showed separation of tunica intima from tunica media. Conclusion: There were endothelial injuries in the arterial specimens after intravascular concentrated hyaluronidase injection. [ABSTRACT FROM AUTHOR]

Background: Hyaluronidase injection is a commonly performed treatment for overcorrection or misplacement of hyaluronic acid (HA) filler. Many patients often wants the HA filler reinjection after the use of hyaluronidase, though the optimal timing of reinjection of HA filler still remains unknown.Objectives: To provide the optimal time interval between hyaluronidase injections and HA filler reinjections.Methods: 6 Sprague–Dawley rats were injected with single monophasic HA filler. 1 week after injection, the injected sites were treated with hyaluronidase. Then, HA fillers were reinjected sequentially with differing time intervals from 30 minutes to 14 days. 1 hour after the reinjection of the last HA filler, all injection sites were excised for histologic evaluation.Results: 3 hours after reinjection of HA filler, the appearance of filler material became evident again, retaining its shape and volume. 6 hours after reinjection, the filler materials restored almost its original volume and there were no significant differences from the positive control.Conclusions: Our data suggest that the hyaluronidase loses its effect in dermis and subcutaneous tissue within 3–6 hours after the injection and successful engraftment of reinjected HA filler can be accomplished 6 hours after the injection. [ABSTRACT FROM PUBLISHER]

Background: Oral submucous fibrosis is a chronic disease, treatment of which has largely been symptomatic. Aloe vera has immunomodulatory, anti-inflammatory, wound healing, antioxidant, and antineoplastic activities. All such properties of aloe vera suggest the possibility of its use in the management of oral submucous fibrosis.Methods: Seventy-four patients of oral submucous fibrosis were randomly divided into 2 groups. Group A patients were treated with systemic (juice) and topical aloe vera (gel) for 3 months. Group B patients were treated with intralesional injection of hydrocortisone and hyaluronidase for 6 weeks with antioxidant supplements for 3 months. Patients were assessed for reduction in burning sensation and increase in mouth opening, cheek flexibility, and tongue protrusion at an interval of 1, 2, and 3 months.Results: Both the groups showed statistically significant improvements in all the study parameters at the end of study period (P < 0.001). The clinical response to aloe vera was comparable to that of intralesional injections of hydrocortisone and hyaluronidase with antioxidant supplementation.Conclusion: The study concludes that aloe vera can be an alternative, safe, and effective treatment regime in the management of oral submucous fibrosis. Long-term follow-up studies with larger sample size are recommended. [ABSTRACT FROM AUTHOR]

Mild swelling and bruising secondary to hyaluronidase injection have been reported; they are typically limited to the area of injection and settle down within a few days.6 However, in the cases reported here, the ecchymosis/edema was severe, extending away from the site of hyaluronidase injection, and resolved slowly despite treatment. The following day patient noticed an improvement of the nodule, but swelling and ecchymosis were extending from the site of hyaluronidase injection medially onto the malar cheek and lower eyelid (Figure 1D). [Extracted from the article]

Hyaluronic acid (HA) fillers have become the material of choice for soft-tissue augmentation of the face. They are longer lasting, less immunogenic and can be broken down by hyaluronidase. These advantages make HA fillers the most common of the temporary fillers on the market. However, early and delayed complications, ranging from minor to severe, can occur following HA-filler injection even if administered by an experienced practictioner. The case of a patient who suffered from chronic infectious and inflammatory complications following the injection of hyaluronic acid is reported. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to compare the effectiveness of vasodilator isoxsuprine to dexamethasone with hyaluronidase injections and physiotherapy in the treatment of oral submucous fibrosis. Materials and methods: Forty patients with oral submucous fibrosis were randomly assigned into three groups. Group A patients ( n = 15) received 10 mg isoxsuprine tablets four times per day, group B ( n = 15) biweekly dexamethasone with hyaluronidase intralesional injections, and group C ( n = 10) placebo tablets. In addition, all patients were instructed physiotherapy exercises. The treatment time was 6 weeks and patients were followed-up for 4 months thereafter. The effect of the treatment was evaluated by measurements of inter-incisal distance and oral burning sensation and evaluation of histological findings of the diseased mucosa. Results: Mouth opening increased and burning sensation decreased significantly in all groups, but the effects were significantly greater in groups receiving either oral isoxsuprine or dexamethasone with hyaluronidase injections in addition to physiotherapy. The decrease in burning sensation occurred more rapidly in patients receiving intralesional dexamethasone with hyaluronidase. Histological improvement was not observed in any of the groups. Conclusions: Oral isoxsuprine as well as dexamethasone with hyaluronidase injections combined to physiotherapy alleviate symptoms of oral submucous fibrosis significantly more efficiently than physiotherapy alone. Clinical relevance: Oral isoxsuprine can be considered as a new candidate drug for the treatment of oral submucous fibrosis. Physiotherapy exercises provide relief of symptoms and should be instructed to all patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding ultrasound-guided injection of hyaluronidase for treatment of hyaluronic acid injection complications.