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Updated: Jun 23, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Micropuncture Decompression With High-Dose Hyaluronidase for Early Reversal of Nasal Ischaemia from HA-Biostimulator
Yau-Li Huang1,2,3, Ben Chung-Pin Liang4,5,6
1Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taipei, Taoyuan, Taiwan.
Background:
Nasal filler-related vascular compromise is uncommon but may result in serious tissue injury. Mixed fillers combining hyaluronic acid (HA) with particulate biostimulators may create emboli with dual-phase rheologic behavior that is not fully addressed in current management algorithms derived largely from HA-only events.
Objectives:
To present an illustrative case and case-derived technical algorithm integrating high-dose hyaluronidase with superficial micropuncture decompression for early nasal ischemia following injection of a mixed HA-biostimulator filler.
Methods:
We describe an illustrative case of dorsal nasal artery ischemia following injection of a premixed HA-calcium hydroxylapatite (CaHA) formulation containing lidocaine with epinephrine. Early-stage ischemia was managed using a dual-approach rescue strategy consisting of track-based high-dose hyaluronidase for enzymatic debulking, followed by tension-guided superficial micropuncture for mechanical decompression, together with adjunctive supportive measures.
Results:
Clinical improvement with reperfusion was observed within 24 to 48 h, with marked improvement by Day 5 and near-complete recovery by Day 7. At 4-week follow-up, the patient showed near-complete recovery without clinically evident scarring, contour irregularity, or atrophy. Pain improved markedly, and patient satisfaction was high.
Conclusions:
In this illustrative case, a dual-approach rescue strategy combining high-dose hyaluronidase with superficial micropuncture was associated with favorable early recovery. This case-derived technical framework may be considered in selected early cases of mixed-filler nasal ischemia, but its independent benefit and generalizability remain uncertain and require further evaluation in larger series.
Level Of Evidence V:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
