Hyaluronidase in the correction of hyaluronic acid‐based fillers: a review and a recommendation for use

Abstract

SummaryBackground Hyaluronic acid (HA) preparations are the most commonly used injectable fillers in esthetic medicine. In contrast to other injectable fillers with hyaluronidase, there is a tool available to reduce unwanted depots of this filler. Aims The aim of this paper is to give an overview on the present literature and in addition to give some recommendations for use based on the experience of the authors. Methods The overview is based on a literature search. Results There is some evidence from two smaller clinical trials that hyaluronidase will effectively decrease injected depots of HA. It has further been shown from case series and case reports that this reduction is clinically relevant. There is less evidence that hyaluronidase is also helpful in adverse reactions to HA-based fillers. Conclusions The reports suggest that the treatment is safe. However, adverse reactions to hyaluronidase such as allergic reactions have been reported. Patient should be informed about that before treatment.

Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances

“…Mixtures of triamcinolone acetonide, HAase and lidocaine for therapy of hypertrophic scars or keloids after laser treatment, applied via Derma Jet, have been also described as being successful [61]. Undesirable results after the use of HA fillers as well as subcutaneous inflammatory nodules can be corrected by enzymatic decomposition with HAase with or without the addition of local anaesthetics [64,65]. …”

Hyaluronidase Caveats in Treating Filler Complications

“…In Germany, for example, bovine origin hyaluronidase-Hylase "Dessau" is patented and manufactured for many decades. 20 In the United Kingdom, Hyalase is distributed by Wockhardt UK Ltd as vials containing 1,500 units of hyaluronidase powder, with no specification of the origin. 21 After reconstituting the enzyme, the product should be used within 6 hours.…”

Fillers in Ophthalmic Practice

“…6 If required, nodules can be dissipated by injection of hyaluronidase. 7 Uncommon complications include inflammatory nodules, allergic reactions, infection, hematomas, granulomas, and blue lump (Tyndall effect). True granulomas can be treated with a low-dose steroid injection and may need to be excised.…”