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Hyperbaric oxygen therapy for treatment of a late presenting ischaemic complication from hyaluronic acid cosmetic filler injection
  1. Farhang Jalilian1,
  2. Samuel P Hetz2,
  3. Joanna Bostwick3,4 and
  4. Sylvain Boet1,5,6,7,8,9,10,11
  1. 1Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Concept Medical, Ottawa, Ontario, Canada
  3. 3University of Ottawa, Ottawa, Ontario, Canada
  4. 4Department of Emergency Medicine, Montfort Hospital, Ottawa, Ontario, Canada
  5. 5Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  6. 6Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
  7. 7Institut du Savoir Montfort, Ottawa, Ontario, Canada
  8. 8Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  9. 9Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
  10. 10Kennan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  11. 11Hyperbaric Medicine Unit, The Ottawa Hospital, Ottawa, Ontario, Canada
  1. Correspondence to Dr Sylvain Boet; sboet{at}


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.

  • Dermatology
  • Unwanted effects / adverse reactions

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  • Contributors FJ drafted the manuscript and contributed to the planning and conduct of this case report. SPH, JB and SB contributed to the planning and conduct of the case report and reviewed the manuscript for important intellectual content. All authors approved of the version to be submitted for publication. SB acts as the guarantor for this work.

  • Funding Dr. Boet was supported by The Ottawa Hospital Anesthesia Alternate Funds Association and the Faculty of Medicine, University of Ottawa with a Tier 2 Clinical Research Chair.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.