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HYALURONIDASE

How to correct hyaluronic acid filler problems

In aesthetic medicine, the use of hyaluronic acid-based fillers gives extremely effective results in the treatment of wrinkles and improvement of the face and lips. This type of treatment is generally safe and well accepted by patients. Unfortunately, complications related to the injection treatment with hyaluronic acid fillers can occur and it is necessary to remove the injected filler. To bring the treated area back to a "normal" condition (i.e. to a pre-treatment condition) hyaluronidase is used, effective only for hyaluronic acid fillers on the market for medical-aesthetic use

La ialuronidasi è un enzima idrolitico presente costituzionalmente nel nostro corpo che serve a degradare l’acido ialuronico. Questo enzima viene riprodotto a livello industriale (da derivazione animale o batterica) e utilizzato come farmaco “per la degradazione controllata dell’acido ialuronico” con molteplici scopi medici. In ambito medico estetico, il suo utilizzo controllato serve per sciogliere i filler cross – linkati di acido ialuronico ad uso dermo estetico.

 

Hyaluronidase is a hydrolytic enzyme constitutionally present in our body that serves to degrade hyaluronic acid. This enzyme is reproduced on an industrial level (from animal or bacterial derivation) and used as a drug “for the controlled degradation of hyaluronic acid” with multiple medical purposes. In the aesthetic medical field, its controlled use is used to dissolve the cross-linked hyaluronic acid fillers for dermal aesthetic use.

In the specific aesthetic medical field, it is used to degrade the cross-linked hyaluronic acid filler. This treatment is performed on an outpatient basis and requires the infiltration of hyaluronidase into the areas to be treated. The quantities are predefined and established by protocols.

VASCULAR OCCLUSION

Due to the accidental injection of hyaluronic acid filler into an artery. Such an event should be treated immediately (refer to Expert Panel on Aesthetic Complications, Necrosis Guidelines). Signs of imminent necrosis include sharp severe pain, prolonged blanching of the skin, and a bruised appearance of surrounding areas. Hyaluronidase should be given as soon as these complications occur.

EXCESSIVE AMOUNT or DISPLACEMENT of the filler

Often caused by poor injection technique or poor product choice for a particular area.

NODULES, GRANULOMAS

Subcutaneous accumulations of hyaluronic acid which may appear up to several months after initial treatment (see Guide to Examination of Delayed Onset Nodules, Aesthetic Complications Expert Panel).

TYNDALL EFFECT

It refers to the bluish discoloration that can be observed in some patients after the injection of hyaluronic acid (refer to Expert on Aesthetic Complications, Tyndall Effect Guide). It is caused by too superficial placement of the hyaluronic acid gel or by using an inappropriate product for the treated area.

The effect is practically immediate: the hyaluronidase immediately degrades the hyaluronic acid filler and eliminates itself as the dosage ends: all within about a minute. Since, like all enzymes, it interrupts itself by itself, it is NOT possible that it will continue to act in the following days. Since the cross-linked hyaluronic acid fillers are never completely absorbed but are integrated into the tissues, the use of hyaluronidase can also be carried out after some time (we have had cases of patients treated 5 years after the infiltration of fillers).

It is therefore an extremely effective solution for dissolving the cross-linked hyaluronic acid from the lips, cheekbones, nasolabial folds and the periocular area, to bring them back to their original situation. Therefore, if the filler treatment was not successful, the problem can be solved, returning exactly to the way it was before the hyaluronic acid filler.

When used in the aesthetic medical field, the required dosage depends on various factors (related to the particular hyaluronic acid filler): quantity of gel, degree of cross-linking, concentration of hyaluronic acid, treated area. There are international recommendations and national protocols which indicate the dosages in the various areas of the face. These dosages must necessarily be respected, despite the fact that it is an off-label use.

HYALURONIDASE SIDE EFFECTS

Local reactions are by far the most common and according to clinical trials occur at a frequency of 0.05% to 0.69% 3. Signs include oedema, erythema, pain and pruritus. Urticaria and angioedema were reported in less than 0.1% of cases. Anaphylaxis has occurred with the use of hyaluronidase when high doses have been given and with intravenous administration. Hyaluronidase is NOT authorized for the correction of aesthetic problems related to the injection of hyaluronic acid fillers. Therefore its use in this sense is OFF-LABEL. If the person is interested in eliminating the residues of hyaluronic acid (or if he runs a serious risk of vascular compromise), he must be informed in advance of all its characteristics, methods of administration and complications.

ABSOLUTE CONTRAINDICATIONS TO THE USE OF HYALURONIDASE:

  • During pregnancy and breastfeeding 
  • History of specific hypersensitivity ascertained to one of the components
  • History of auto-immune or immune system diseases
  • Presence of active herpes, acne and rosacea 
  • Injection of permanent products (silicone, acrylic polymers) 
  • Untreated infectious periodontitis, pulpitis, cellulitis of dental or otorhinolaryngological origin, dental abscesses that have not been treated or have been treated for less than a week. 
  • Tendency to develop keloid scars 
  • Treatment of damaged skin and/or with infectious and/or inflammatory problems 
  • Therapies in progress, contraindicated due to supposed slowdowns and/or delays in the reparative phase 
  • Therapies with non-steroidal anti-inflammatory drugs, aspirin, anticoagulants
  • Presence of unknown fillers
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WHAT HAPPENS AFTER THE HYALURONIDASE

Other common injection-related reactions may occur after the procedure. These reactions include redness, swelling, pain, itching, bruising and tenderness at the injection site. They have generally been described as mild to moderate and usually resolve spontaneously within a few days after injection. You can resume your activities after about 2 days, paying attention to: 

    • Do not subject yourself to excessive temperatures (saunas, hammams, sunlamps) in the following 15 days 
    • Do not engage in sports or strenuous exercise for the next 72 hours
    • Do not take alcohol
    • Do not take anticoagulant drugs (NSAIDs, aspirin) in the following 3 days, unless for concomitant pathologies of specialist medical competence
    • Do not have any dental procedures or other cosmetic procedures for the next 15 days
    • Do not rub the treated area vigorously for the next 24 hours and do not apply any type of make-up or cream for at least 12 hours after treatment. 
    • Do not apply topical medications such as cortisone creams and the like to the affected areas
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