ArticleAesthetic plastic surgery2026
Micropuncture Decompression With High-Dose Hyaluronidase for Early Reversal of Nasal Ischaemia from HA-Biostimulator Mixed Fillers: An Illustrative Case and Technical Algorithm.
Article in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNasal 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.
objectivesTo 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.
methodsWe 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.
resultsClinical 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.
conclusionsIn 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 .
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