The Efficacy of High-Dose Pulsed Hyaluronidase in Ischemia Following Hyaluronic Acid Fillers: A Retrospective Study of 47 Patients Publisher



Nazari S ; Hadadian N ; Rezaei E ; Pakdel F ; Fakih Gomez N ; Pourani M R
Source: Dermatologic Therapy Published:2026

Abstract

Background: Hyaluronic acid (HA) injections, primarily used as dermal fillers, have become popular over the past 2 decades. However, filler injections can lead to severe complications, such as ischemia, with hyaluronidase (HYAL) being the primary treatment. Objectives: The study aimed to evaluate the effects of the high-dose pulsed hyaluronidase (HDPH) protocol, which involves administering repeated doses of HYAL exceeding 500 IU. Methods: A retrospective observational study was conducted in a private clinic between 2018 and 2023, analyzing 47 cases divided into two groups: Group A, treated with the HDPH protocol, and Group B, which served as the natural history comparison cohort illustrating outcomes associated with delayed presentation and received the palliative therapeutic regimen. Results: In Group A (n = 29), advanced ischemia was significantly associated with scar formation (p = 0.01). Patients treated with HDPH (Group A) had a lower rate of scar formation (13.8%), while all receiving palliative therapies experienced scar formation (Group B) (100%). Overall, the HDPH protocol is associated with reduced scar formation. Conclusion: The study highlights the potential role of the HDPH protocol in the management of ischemia. Early administration of HDPH improves clinical outcomes, highlighting the importance of physician training in its application for vascular-related ischemia. Routine follow-up after filler injections is essential for the early detection and timely treatment of ischemia. Copyright © 2026 Shahriar Nazari et al. Dermatologic Therapy published by John Wiley & Sons Ltd.