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Background <p>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.</p> Objectives <p>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.</p> Methods <p>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.</p> Results <p>Clinical improvement with reperfusion was observed within 24 to 48&#xa0;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.</p> Conclusions <p>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.</p> Level of Evidence V <p>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 <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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Micropuncture Decompression With High-Dose Hyaluronidase for Early Reversal of Nasal Ischaemia from HA–Biostimulator Mixed Fillers: An Illustrative Case and Technical Algorithm

  • 期刊论文

  • 发表日期：

    2026年6月22日

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  • Yau-Li Huang,
  • Ben Chung-Pin Liang

摘要

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.