Hyaluronidase: What is your fear?

Abstract

Aesthetic treatment with hyaluronic acid (HA)-based fillers has shown a growing demand and becoming a choice as an option in minimally invasive rejuvenation, either as a volumizer in cases of tissue loss, facial contouring with definition or correction of rhytids. 1,2 As the HA injections had increased, the reports of adverse events related to it also raised. The first-line treatment of these undesirable effects is hyaluronidase (HYAL). 3,4 HYAL is a natural enzyme that degrades hyaluronic acid and can be used in the management of the majority of adverse events related to the use of this filler, such as overcorrections like nodules and bumps, Tyndall effect or late nodules, and even more severe complications as tissue ischemia. 1,5 This study aims to describe the safety and effectiveness of the use of HYAL in the correction of undesirable results of hyaluronic acid fillers in 114 patients in private dermatologic practice. | MATERIAL S AND ME THODSA retrospective study of 114 patients submitted to the application of HYAL (hyaluronidase 2.000 UI, BIOMETIL tm ) was performed to correct unaesthetic effects after filler injections on the face. Cases were selected from a private clinic from June 2015 to November 2018 by reviewing charts and analyzing photographic documentation, and the following data were evaluated: age, gender, the indication of use, the anatomical unit involved, number of sessions, amount of HYAL used, and adverse effects after the application of

Extensive ecchymosis and edema associated with injection of human hyaluronidase in the periorbital area: A report of three cases

“…Mild swelling and bruising secondary to hyaluronidase injection have been reported; they are typically limited to the area of injection and settle down within a few days. 6 However, in the cases reported here, the ecchymosis/edema was severe, extending away from the site of hyaluronidase injection, and resolved slowly despite treatment. Hyaluronidase decreases the viscosity of the cellular cement and promotes dispersion of injected fluids, localized transudates, or exudates.…”

Case Report: Reversal of Hyaluronic Acid Rectal Wall Infiltration with Hyaluronidase

“…HA was first approved for use as a cosmetic filler by the United States’ Food and Drug Administration (FDA) in 2003, and since then, it has experienced exponential growth in popularity and use ( 2 ). A unique property of HA, including HA that is misplaced or overfilled, is that it can be reversed with HAS ( 8 ). This ability to reverse and remodel hyaluronic acid is advantageous as it allows correction of any inaccurately placed product and can minimise adverse events, as in our case.…”

Does hyaluronidase injected in periocular area change skin ultrastructure?: Standardized in vitro analysis

“…HA concentration is 0.5 to 1 mg/g in the dermis and decreases with age, this being one of the most important milestones in skin aging 1,3 . For this reason, treatment with HA fillers as a cosmetic strategy for skin rejuvenation has experienced a significant growth in recent years with a proportional increase in its complications, being hyaluronidase the most widespread treatment for them 1–15 . If exogenous hyaluronidase could affect endogenous HA of the skin in addition to dissolving the injected HA product and impair skin ultrastructure is a question that remains open and an approximation of its response is the aim of the present research.…”

“…Overcorrection, superficial hyaluronic acid implantation, inflammatory or noninflammatory nodules, infection, vascular occlusion and two exclusive periocular area complications: dyschromia ("Tyndall effect") and palpebral edema (of early or late onset) have been described elsewhere 1‐11 . Hyaluronidase is the most widespread option of treatment for HA filler's complications 1‐15 . It has been shown to be effective in dissolving HA early and late‐onset nodules, correcting overvolume or treating acute skin vascular occlusions 1‐3,14 …”

“…[1][2][3][4][5][6][7][8][9][10][11] Hyaluronidase is the most widespread option of treatment for HA filler's complications. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] It has been shown to be effective in dissolving HA early and late-onset nodules, correcting overvolume or treating acute skin vascular occlusions. [1][2][3]14 In the periocular area, hyaluronidase has been successfully used to revert eyelid edema and blue-gray dyschromia related to tear trough treatment.…”