Hyaluronidase Protocol in Management of Hyaluronic Acid Filler-Related Vascular Complications: A Systematic Review...

Hyaluronic acid (HA) fillers are widely used in aesthetic procedures but can lead to serious vascular complications, including skin necrosis and visual impairment. The timely administration of hyaluronidase (HYAL) is critical for mitigating these adverse effects. This systematic review and meta-analysis aim to evaluate the efficacy and propose a management protocol of HYAL in managing HA-related vascular complications.

A comprehensive literature search was conducted across MEDLINE, PubMed, Cochrane, and Web of Science for studies published from 2000 to February 2025. Eligible studies included randomized controlled trials, cohort studies, and case series involving HYAL treatment for HA-related complications. Data extraction focused on treatment protocols, patient demographics, outcomes, and resolution rates.

Twenty-one studies involving 231 patients were included. The mean age was 30.1 years, with a predominance of female patients (90.9%). Skin necrosis occurred in 60.6% of cases and visual impairment in 52.8%. The overall resolution rates for skin necrosis and visual impairment were 78.4% and 45.2%, respectively. Early intervention (within 6 hours) significantly improved outcomes, with higher doses of HYAL correlating with better resolution rates in skin necrosis.

This study underscores the effectiveness of hyaluronidase in treating HA-related vascular complications, particularly when administered promptly. The findings support the establishment of standardized treatment protocols to enhance patient safety and outcomes in aesthetic practices. Future research should focus on optimizing dosing strategies and further elucidating the role of adjunctive therapies.

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