{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T20:17:31Z","timestamp":1767212251503,"version":"build-2065373602"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vision loss following cosmetic filler injections is a rare but devastating complication resulting from inadvertent intravascular embolization, most often affecting the ophthalmic artery. Retrobulbar hyaluronidase injection has been proposed as an emergency intervention, yet anatomical guidelines for its administration remain poorly defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To propose an anatomically informed protocol for safe and effective retrobulbar hyaluronidase injection in cases of filler\u2010induced central retinal artery occlusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cadaveric dissections and micro\u2010CT imaging were used to map orbital anatomy, focusing on the spatial relationship between the optic nerve, ophthalmic artery, and adjacent structures. The inferolateral quadrant was identified as the safest trajectory for retrobulbar injection, minimizing risk to ocular muscles and nerves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The optimal needle trajectory was from the inferolateral orbital rim toward the superior medial quadrant, avoiding critical neurovascular structures. A 35\u2009mm, 22\u201323G needle was deemed appropriate for reaching the retrobulbar space while minimizing the risk of globe perforation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides a standardized anatomical approach for retrobulbar hyaluronidase injection, aiming to improve safety and potentially restore perfusion in acute filler\u2010induced visual loss. Clinical implementation should proceed with caution and in multidisciplinary settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.70378","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T10:25:20Z","timestamp":1754389520000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anatomical Guideline for Retrobulbar Hyaluronidase Injection"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5572-1364","authenticated-orcid":false,"given":"Kyu\u2010Ho","family":"Yi","sequence":"first","affiliation":[{"name":"Division in Anatomy and Developmental Biology, Department of Oral Biology Human Identification Research Institute, BK21FOUR Project, Yonsei University College of Dentistry  Seoul Korea"},{"name":"You and I Clinic  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin\u2010Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"You and I Clinic  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Earl","family":"Lee","sequence":"additional","affiliation":[{"name":"Re &amp; Re Plastic Surgery Clinic  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong Keun","family":"Song","sequence":"additional","affiliation":[{"name":"Pixelab Plastic Surgery Clinic  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byungki","family":"Cho","sequence":"additional","affiliation":[{"name":"It's Me Clinic  Sejong Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2576-5723","authenticated-orcid":false,"given":"Soo\u2010Bin","family":"Kim","sequence":"additional","affiliation":[{"name":"Institute of Biomaterial Implant, Department of Oral Anatomy, College of Dentistry Wonkwang University, Iksan 54538, Republic of Korea  Iksan Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002763"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003851"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000007047"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002172"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.16064"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjac329"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X14525035"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000558"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/2474126419834782"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0b013e3182288e4d"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000524353"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2011.07.013"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010022\u201003215\u20109"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjw216"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000001132"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.18240\/ijo.2020.07.25"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000005806"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-019-01388-4"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000001237"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oftal.2022.03.002"}],"container-title":["Journal of Cosmetic Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.70378","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T02:04:06Z","timestamp":1760061846000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocd.70378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1111\/jocd.70378"],"URL":"https:\/\/doi.org\/10.1111\/jocd.70378","archive":["Portico"],"relation":{},"ISSN":["1473-2130","1473-2165"],"issn-type":[{"type":"print","value":"1473-2130"},{"type":"electronic","value":"1473-2165"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70378"}}