Hyaluronidase 1,500unit powder for solution for injection ampoules

The use of fillers for cosmetic purposes has increased in recent years. Although generally considered safe, fillers are not exempt from complications, including ischemic events. Arterial ischemia is a rare but potentially serious complication that requires prompt recognition and management. Ultrasound-guided hyaluronidase injection is emerging as a precise and effective treatment approach. The authors present a pictorial case series of filler-induced arterial ischemia managed with ultrasound-guided hyaluronidase injections, and systematically review the literature on ultrasound findings, enzyme dosage, time to resolution, and overall effectiveness of this approach. They present 3 cases of filler-induced arterial ischemia in the frontal, nasal, and temporal regions with visible intravascular thrombosis managed with ultrasound-guided intravascular hyaluronidase injections. Additionally, the authors systematically reviewed literature from PubMed/Medline, Scopus, Embase, and Web of Science up to August 2024 to evaluate the effectiveness, dosage, and ultrasound techniques utilized in the ultrasound-guided treatment of vascular complications from hyaluronic acid fillers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened 88 studies, finally including 9 studies after full-text evaluation. Data from these studies, alongside our 3 cases (totaling 83 cases), showed rapid resolution of symptoms and ultrasound abnormalities following ultrasound-guided hyaluronidase injections. Delayed hyaluronidase administration was associated with slower or incomplete recovery, highlighting the importance of early intervention. Ultrasound-guided hyaluronidase injections effectively resolve arterial ischemia caused by filler injections, with early intervention significantly enhancing outcomes. Prompt diagnosis and timely ultrasound-guided intervention should be emphasized in clinical practice. Further large-scale randomized studies are necessary to establish standardized treatment protocols for dosage and timing. Level of Evidence: 3 (Therapeutic).

Abstract licence: CC BY

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy associated with pain, sensory disturbances, functional impairment, and reduced quality of life. Hyaluronidase, an enzyme capable of degrading hyaluronic acid and facilitating perineural hydrodissection, has emerged as a potential minimally invasive treatment option for CTS. This systematic review and meta-analysis evaluated the effectiveness of hyaluronidase injections in CTS compared with other injection therapies. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review and meta-analysis was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251046156). PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched, supplemented by Google Scholar, Ovid Discovery, and ClinicalKey. Randomized controlled trials comparing hyaluronidase injections with control interventions in adults with CTS were included. Primary outcomes included symptom severity scale (SSS), functional status scale (FSS), sensory nerve conduction velocity (SNCV), and distal motor latency (DML). Secondary outcomes included visual analogue scale (VAS) and cross-sectional area (CSA) of the median nerve. Random-effects meta-analysis was performed using IBM SPSS Statistics for Windows, Version 31.0 (IBM Corp., Armonk, New York, United States). Risk of bias and certainty of evidence were assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. Four randomized controlled trials involving 230 participants were included. Primary pooled analyses demonstrated directional trends favoring hyaluronidase for SSS at three months (MD=-0.17; 95% CI=-0.65 to 0.31) and six months (MD=-0.42; 95% CI=-1.29 to 0.45), FSS at three months (MD=-0.23; 95% CI=-0.95 to 0.49) and six months (MD=-0.30; 95% CI=-1.13 to 0.54), DML at three months (MD=-0.21 ms; 95% CI=-0.68 to 0.25) and six months (MD=-0.55 ms; 95% CI=-1.14 to 0.03), and SNCV at three months (MD=0.56 m/s; 95% CI=-3.57 to 4.69) and six months (MD=2.23 m/s; 95% CI=-2.88 to 7.34); however, none of these primary outcomes reached statistical significance. Pooled analysis demonstrated a statistically significant reduction in VAS scores at six months favoring hyaluronidase (MD=-1.97; 95% CI=-3.88 to -0.06; p=0.04). Subgroup analyses demonstrated significantly greater improvement with hyaluronidase compared with dexamethasone for SSS, FSS, and DML at the six-month follow-up. Considerable heterogeneity was observed across most pooled analyses, and sensitivity analyses identified one study as the principal contributor to heterogeneity. The certainty of evidence for primary outcomes was low. Current evidence does not demonstrate a consistent or statistically robust benefit of hyaluronidase injection in improving symptom severity, functional status, DML, and SNCV in CTS, although directional trends and subgroup findings suggest potential benefit in specific comparisons, particularly against dexamethasone. Further high-quality, adequately powered randomized controlled trials with standardized outcome measures are required to establish its effectiveness.

Abstract licence: CC BY

BackgroundHyaluronic acid (HA)-based soft-tissue fillers are the most widely used injectables for nonsurgical facial rejuvenation, valued for their reversibility, versatility, and safety profile. Despite widespread use, misconceptions about HA gels have proliferated on social media and in clinical discourse, potentially affecting both healthcare professionals and patients.MethodsWe conducted a narrative, nonsystematic review of the published literature, supplemented by clinical experience and expert opinion of 8 international specialists in aesthetic medicine. Published studies in English were retrieved from PubMed, with priority given to systematic reviews, meta-analyses, and controlled clinical trials. Evidence grading and quality assessment were applied where available.ResultsAvailable evidence indicates that HA gels are biodegradable and temporary, with clinical effects generally lasting 4-18 months depending on product, technique, and patient factors. They are reversible through exogenous hyaluronidase injection. Current HA products cross-linked with 1,4-butanediol diglycidyl ether are not associated with toxicity at clinically used concentrations. The risk of gel migration or facial overfill syndrome is not inherent to the products but linked to inadequate anatomical knowledge, suboptimal injection technique, or inappropriate patient selection and counseling. HA gel treatment has also been associated with biostimulatory effects and improvements in patient quality of life.ConclusionsThe weight of published evidence does not support common misconceptions about HA injectable gels. However, the evidence base is heterogeneous and includes studies of variable methodological quality. Practitioner education, thorough treatment planning, and shared decision-making between healthcare professionals and patients remain important for the safe and effective use of HA injectables.

Abstract licence: CC BY-NC-ND