Investigation of the efficacy of hyaluronidase-enoxaparin combined therapy in resolving artery occlusion due to hyaluronic acid filling in rats

Non-surgical facial rejuvenation procedures have become increasingly common in recent years. One of the most frequently used methods among these procedures is hyaluronic acid (HA) filler application. With the increasing prevalence of these applications, frightening vascular complications such as necrosis and blindness have begun to be seen more frequently. In our study, it was aimed to investigate the efficacy of hyaluronidase (hyal) and enoxaparin combined therapy for the treatment of these complications. In our study, hyaluronic acid vascular occlusion model was used on rats. 18 rats were divided into 3 groups of 6 rats. Bilateral oblique groin flap was elevated from the rats in the first group. The flaps on the left side of these 6 rats were named Group 1 (Sham group) and the flaps on the right side were named Group 2 (Control group). In group 1, flaps were elevated. They were inserted to their place and sutured without any additional operation. After the flaps were elevated in group 2, HA filler was given to the supeficial epigastric artery feeding the flap. Group 3 was given hyal enzyme together with the filler. Group 4 was given hyal enzyme and enoxaparin together with the filler. After 1 week, the rats were sacrificed and the findings were evaluated macroscopically and histopathologically. According to the macroscopic comparison of the percentage of necrosis, the percentage of necrosis was found to be statistically significantly lower in group 4 compared to group 3. In addition, there was no significant difference in the percentage of necrosis between group 1, which did not receive fillers, and group 4, where hyal and enoxaparin were given together. This experimental study demonstrated the efficacy of subcutaneous enoxaparin therapy combined with intravascular hyaluronidase in vascular complications of HA filler