Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients

Abstract

BackgroundHyaluronidase (Hylase Dessau®) is a hyaluronic acid-metabolizing enzyme, which has been shown to loosen the extracellular matrix, thereby improving the diffusion of local anesthetics. Lower eyelid edema is a common post-interventional complication of cosmetic procedures performed in the lid region, such as the injection of hyaluronic acid fillers for tear-trough augmentation. The purpose of this study was to validate the efficacy of hyaluronidase in the management of lower eyelid edema.MethodsWe performed a retrospective analysis with 20 patients with lower eyelid edema. Most patients (n = 14) presented with edema following hyaluronic acid injection (tear-trough augmentation), whereas the minority (n = 6) were treated due to idiopathic edema (malar edema or malar mounds). Patients were treated by local infiltration of approximately 0.2 ml to 0.5 ml of hyaluronidase (Hylase Dessau® 20 IU to 75 IU) per eyelid. Photographs were taken prior to and seven days after infiltration.ResultsHyaluronidase was found to reduce effectively and rapidly or resolve eyelid edema after a single injection. No relevant adverse effects were observed. However, it must be noted that a hyaluronidase injection may also dissolve injected hyaluronic acid fillers and may therefore negatively affect tear-trough augmentations. While the effects of a treatment for edema due to tear-trough augmentation were permanent, malar edema and malar mounds reoccurred within two to three weeks.ConclusionThe infiltration of hyaluronidase is rapid, safe and currently the only effective option for the management of eyelid edema. No relevant adverse effects were observed.

Hyaluronidase Caveats in Treating Filler Complications

“…It is also the author's and others' experience that overfills, superficial implantation, and inflammatory reactions by Restylane can be rapidly corrected by 1.5 to 150 units of the hyaluronidase ( Figure 1A-D). [6][7][8][9]20,[58][59][60] For more resistant gels, higher doses or repetitive injections of the enzyme are required. 7, 58 Jones and colleagues 53 suggested a rule of thumb: for each 0.1 mL of HA to be eradicated in vivo, the clinician should begin with 5 units of hyaluronidase for Restylane and 10 units for Juvederm.…”

“…[3][4][5] In the past years, hyaluronidase was used to treat HA filler-induced complications . [6][7][8][9] Despite universal use of hyaluronidase for this indication, multiple aspects remain obscure. Based on published literature and personal experience, the author elucidates questions regarding the appropriate dosage, timing, and technique of hyaluronidase delivery, differences in interaction patterns between the enzyme and different HA gels, and hyaluronidase safety issues.…”

Abobotulinum toxin A and fillers for facial rejuvenation: My experience and technique

“…In case of ischemic complication always after HA injections, the usual suggestion and mine personal remains [13]:…”

“…Naso labial folds are mainly a volumetrical problem but we can't forget that sometimes the mimical origin is possible and in these rare cases AboTA is the right procedure [1,3,5]. The presence of important arteries says as to be very prudent, use maybe cannulas, better then needles and know how to use hyaluronidase in any possible rare case of ischemy [3,5,10,15,13].…”

Identification and characterization of a bacterial hyaluronidase and its production in recombinant form

“…Hyal has been used in clinical practice for more than 50 years to increase tissue permeability and promote the spread or dispersion of other coinjected drugs, particularly local anaesthetics ; for use in the treatment of oedema, local inflammatory states, haemorrhoids, and chilblains; and as an adjunct to induce a significant reduction in the size of myocardial infarction . These commercial, clinical formulations employ animal‐derived Hyals (bovine or ovine testicular Hyal) whose hydrolysis mechanisms have been studied extensively .…”