A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

Abstract

Background Hyaluronidase is used as an adjunct or main treatment to manage complications associated with cosmetic hyaluronic acid (HA) filler injections such as necrosis, blindness, hypersensitivity, delayed nodules, and poor aesthetic outcomes. Objective To systematically map the available evidence and identify the gaps in knowledge on the effectiveness of hyaluronidase use in managing the aesthetic complications associated with HA injections (vascular occlusion, blindness, nodules, delayed hypersensivity, granuloma, poor aesthetic outcome). Methods PubMed, Medline, Embase and Cochrane databases were used up to May 2022, to look for randomized clinical trials (RCTs), clinical trials, and retrospective case-control studies reporting on the use of hyaluronidase for managing the HA filler injection complications. Results The database search yielded 395 studies; of those 5 RCTs (all carried out in the USA) were selected (53 subjects), indicating the effectiveness of hyaluronidase for removal of un-complicated injected HA nodules (forearm, upper arm, or back skin). The follow-ups ranged from 14 days to 4 years. The amount of HA filler injected into each site varied from 0.2 to 0.4 mL. A dose dependent response was observed for most HA fillers. No major adverse reactions were reported. Overall, for removal of every 0.1 mL of HA filler they injected 1.25–37.5 units of hyaluronidase (single injections). When 3 consecutive weekly hyaluronidase injection was used much lower doses of 0.375–2.25 unit was utilised. There was no evidence in a form of RCTs, clinical trials, and retrospective case-control studies on the removal/reversal of HA injections in the facial skin, or management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with HA filler injection. Conclusion Based on studies on the forearm, upper arm and back skin, hyaluronidase can be used for the reversal of uncomplicated HA filler injection nodule. However, further adequately powered studies are warranted to establish the ideal treatment protocol/dose of hyaluronidase for reversal of HA filler injections in the facial region or management of complications associated with aesthetic HA injection. Level of Evidence III 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.

Hyaluronic Acid in Rheumatology

“…Hyaluronic acid (HA) plays an important role in a wide range of medical physiological and pathological conditions: Notably, it finds application in dermatology, ophthalmology, cosmetic medicine, and rheumatology [ 1 , 2 , 3 ]. Its significance extends to wound healing, granulation, and cell migration [ 4 ].…”

Application of dual‐frequency ultrasound for reduction of perilesional edema and ecchymosis after rhinoseptoplasty

“…This is the reason for a broad application of hyaluronidase for the treatment of edema and hematoma. 20 LDM of higher intensities can produce a thixotropic effect-transformation of the HA-bounded water into free water that is much less viscous and can be more easily removed from the tissue. 21,22 Additionally, mathematical modeling revealed that high-frequency ultrasound waves produce sufficient temperature gradients in dermis and subcutis that can significantly enhance the transport rates in the skin.…”

“…This accumulation leads to increased viscosity of the extracellular matrix and thus to a substantial reduction of transport rates in affected tissue. This is the reason for a broad application of hyaluronidase for the treatment of edema and hematoma 20 …”