Jalilian F, Hetz SP, Bostwick J, Boet S, et al.
BMJ case reports. Date of publication 2022 Jul 7;volume 15(7):.
1. BMJ Case Rep. 2022 Jul 7;15(7):e249190. doi: 10.1136/bcr-2022-249190.
Hyperbaric oxygen therapy for treatment of a late presenting ischaemic
complication from hyaluronic acid cosmetic filler injection.
Jalilian F(1), Hetz SP(2), Bostwick J(3)(4), Boet S(5)(6)(7)(8)(9)(10)(11)(12).
Author information:
(1)Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa,
Ontario, Canada.
(2)Concept Medical, Ottawa, Ontario, Canada.
(3)University of Ottawa, Ottawa, Ontario, Canada.
(4)Department of Emergency Medicine, Montfort Hospital, Ottawa, Ontario, Canada.
(5)Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa,
Ontario, Canada sboet@toh.ca.
(6)Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada.
(7)Department of Innovation in Medical Education, University of Ottawa, Ottawa,
Ontario, Canada.
(8)Institut du Savoir Montfort, Ottawa, Ontario, Canada.
(9)Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa,
Ontario, Canada.
(10)Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada.
(11)Kennan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario,
Canada.
(12)Hyperbaric Medicine Unit, The Ottawa Hospital, Ottawa, Ontario, Canada.
Vascular compromise and resulting ischaemic injury are known rare complications
of cosmetic filler injections. Most hyaluronic acid vascular compromises present
early and can be treated effectively by hyaluronidase. Here we present a case of
ischaemic wound and mucosal necrosis after cosmetic facial hyaluronic acid
injection that appeared within hours of injection but was not diagnosed and
treated for 5 days. At day 5, the patient was treated with hyaluronidase
injection immediately followed by 14 sessions of daily hyperbaric oxygen therapy
(HBOT). Despite the delayed treatment, the patient had essentially complete
recovery and the hyperbaric therapy was overall well-tolerated. Our case report
suggests that hyaluronidase injection with concurrent daily HBOT sessions may be
effective to allow recovery from late-presenting filler ischaemic complication.
Furthermore, given the safety profile of HBOT, we suggest a more deliberate
approach to this modality as a therapeutic adjunct by cosmetic practitioners
when similar complications arise.
© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2022-249190
PMCID: PMC9263929
PMID: 35798493 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
