Share this article on:

Local Cooling as a Step of Treatment for Tissue Ischemia Caused by Hyaluronic Acid Injection-induced Embolism—A Report of 9 Cases

Zhang, Chen, MD, PhD*; Ge, Chunying, MD; Du, Chunxiao, Med B*; Li, Jieqi, MD

Plastic and Reconstructive Surgery – Global Open: August 8, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001824
Latest Articles: PDF Only

Summary: Hyaluronic acid injection is 1 of the most popular procedures in facial rejuvenation and augmentation. It is widely popular in the cosmetic surgery due to several advantages, which include rapid effect, minimal injury, and a short postoperative recovery period. With continuous increase in hyaluronic acid injections, many cases of hyaluronic acid injection-induced embolism have been reported. At present, methods for early treatment of hyaluronic acid injection–induced embolism include local injection of hyaluronidase, topical application of nitroglycerin ointment, massage, hot compression, and intravenous injections of antibiotics and hormones. Although early warm massage may facilitate hyaluronic acid degradation by hyaluronidase, local application of heat will also increase metabolic rate in the tissue, thereby reducing the ischemic tolerance of the tissue. Therefore, in this study, warm massage was limited to the first 30 minutes after hyaluronidase injection and was followed by local cooling using a gauze pad soaked with antibiotic saline solution. Excellent therapeutic effects were achieved with this approach. The methods of treatment for tissue ischemia caused by hyaluronic acid injection–induced embolism and clinical cases are introduced in the article.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

From the *Institute of Plastic Surgery, Dalian University, Dalian, China

NY Fashion Clinic, Dalian, China

Shenyang Mylike Aesthetic Hospital, Shenyang, China.

Published online 8 August 2018.

Received for publication April 9, 2018; accepted April 17, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Supplemental digital content is available for this article. Clickable URL citations appear in the text.

Chen Zhang, MD, PhD, Institute of Plastic Surgery, Dalian University, 156 Wansui Street, Dalian City, Liaoning 116021, China, E-mail:

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.