Duplex ultrasonography (DUS) can be used to detect hyaluronic acid (HA) filler-causing intra-arterial obstruction, according to a study published in the January issue of the Journal of the American Academy of Dermatology .

Noting that complications, including serious vascular events, occur with use of HA filler treatments, Leonie W. Schelke, M.D., from the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues aimed to improve treatment outcomes after a vascular adverse event. Twenty-one patients, aged 18 years or older, were enrolled from July 2018 through May 2019. All patients underwent physical and DUS examination of the affected area on arrival at an outpatient clinic. The treating physician attempted to inject 35 to 50 units of hyaluronidase into the obstructing intravascular bolus of filler under ultrasonographic guidance.

The researchers found that all 21 patients with a vascular adverse event due to HA fillers were treated with hyaluronidase injections that were guided ultrasonographically. After injection of hyaluronidase into the deposits responsible for the occlusion, blood flow was immediately restored. After restoration of blood flow, clinical improvement of the livedo reticularis aspect of the skin was noted. A second treatment session was performed within 24 hours of the initial treatment in seven patients.

"The use of DUS for facial arterial mapping, safe deployment of HA, and directed low-dose hyaluronidase reversal of impending intravascular adverse events is a welcome technological advancement," the authors write.

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