Aesthetic Plastic Surgery

, Volume 43, Issue 5, pp 1337–1344 | Cite as

Reversal of Post-filler Vision Loss and Skin Ischaemia with High-Dose Pulsed Hyaluronidase Injections

  • Almond Wibowo
  • Krishan Mohan KapoorEmail author
  • Wolfgang G. Philipp-Dormston
Case Report Non-Surgical Aesthetic


Nose filler injections are very popular in many Asian countries to improve nose shape and projection. However, due to the vascular supply of nose from the ophthalmic artery and its communication with branches of the facial artery in this region, there could be a possibility of ophthalmic complications in case of an accidental intra-arterial injection of filler material. This may cause devastating complications of partial or complete vision loss with or without associated cutaneous ischaemic changes. We present a case report of a patient who developed features of vascular involvement after two ml of HA filler injection in the nasal dorsum, tip and columella. The patient initially developed tell-tale signs of impending skin necrosis in the nasal and forehead skin followed by ptosis, severe pain and progressive vision loss in the right eye until a point where the patient could only perceive light. The patient was managed with multiple doses of hyaluronidase in the involved skin and two doses of retrobulbar injection for vision loss. Significant recovery in the skin and ophthalmic components occurred within 20 days of filler injection. This case demonstrates that recovery of the ischaemic ophthalmic and cutaneous changes secondary to probable intra-arterial injection could be accomplished using combined retrobulbar and periorbital intracutaneous injections of high-dose pulsed hyaluronidase.

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


Fillers Vision loss Blindness Hyaluronidase Ischaemia Nose filler 



High dose pulsed hyaluronidase


Hyaluronic acid


External carotid artery


Internal carotid artery


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent of the patient was taken for this case report.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Privee ClinicJakartaIndonesia
  2. 2.Anticlock ClinicChandigarhIndia
  3. 3.Department of Plastic SurgeryFortis HospitalMohaliIndia
  4. 4.St George’s University of LondonLondonUK
  5. 5.Hautzentrum Koeln, Klinik Links vom RheinCologneGermany

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