Nitroglycerin, or Not, When Treating Impending Filler Necrosis

Area of Science:

• Dermatology
• Plastic Surgery
• Aesthetic Medicine

Background:

• Dermal necrosis is a rare but severe complication of cosmetic filler injections.
• Hyaluronidase is the current standard treatment for hyaluronic acid filler-induced necrosis.
• The effectiveness of topical nitroglycerin for this condition remains under-investigated.

Purpose of the Study:

• To review existing literature on filler-induced tissue necrosis.
• To evaluate topical nitroglycerin as a potential first-line treatment for dermal necrosis.

Main Methods:

• A comprehensive literature review was conducted without time restrictions.
• 35 articles detailing 66 cases of filler-induced tissue necrosis were analyzed.

Main Results:

• Topical nitroglycerin was used in only 7 of 66 cases (10%), achieving an 85% success rate in preventing necrosis.
• Hyaluronidase injections were the most common alternative treatment (59 patients).
• Novel treatments like growth factors and stem cells were also reported.

Conclusions:

• Topical nitroglycerin is an underutilized and potentially effective treatment for filler-induced dermal necrosis.
• Due to limited data, it should be used alongside hyaluronidase for hyaluronic acid filler necrosis.