Enzyme hyaluronidase in cosmetology: elimination of side effects of fillers

Hyaluronic acid-based fillers are often used for facial correction due to their simplicity, minimally invasiveness, relatively consistent results, and safety. However, these fillers can cause complications such as overfilling, allergy or hypersensitivity, granulomas, material migration, the Tyndall effect, unwanted persistence and, in rare cases, focal necrosis. To eliminate such side effects in the shortest possible time, the enzyme hyaluronidase is used.

The enzyme hyaluronidase and its effect on hyaluronic acid

Hyaluronic acid is a glycosaminoglycan found in human skin, joint synovial fluid, cartilage and the vitreous body of the eye. For use as a dermal filler, the properties of hyaluronic acid are adjusted. There are different types of fillers with different structural properties.

Enzyme hyaluronidase – it is a natural enzyme that promotes local degradation of shialuronic acid. Due to this property, it is used to correct or modify injected fillers based on hyaluronic acid.

Application of hyaluronidase enzyme in cosmetology

1.  In the case of the introduction of an excess amount of stabilized hyaluronic acid, the hyaluronidase enzyme allows you to get rid of the signs of hypercorrection in the case of superficial injection of fillers based on HA, migration of HA, and an incorrectly selected preparation. It is worth noting that after the introduction of the hyaluronidase enzyme, the patient is under the supervision of a doctor for an hour, and then comes for a second examination after 2 days.

2.  One of the most serious complications of HA-based fillers is necrosis due to the injection of stabilized HA into vessels. Prevention of necrosis is possible with the immediate administration of the enzyme hyaluronidase.                                                          

3.  Tyndall effect is a change in skin color in the area of ​​​​filler injection.       Hyaluronidase allows you to restore normal complexion in this case.

4.  A delayed allergic reaction to HA can also manifest as granulomas accompanied by symptoms of inflammation. If the granulomas do not disappear spontaneously after some time, it may be necessary to administer the enzyme hyaluronidase to dissolve the HA.

Allergy to hyaluronidase enzyme and possible side effects

During the administration of the hyaluronidase enzyme, painful sensations are possible, therefore it is sometimes administered with local anesthetics.

Skin hyperemia and edema occur in 25% of cases and usually subside after 48-72 hours.

Symptoms in case of an overdose of hyaluronidase enzyme:

• nausea;
• vomit;
• chills;
• dizziness;
• tachycardia;
• pressure drop.

Symptoms of allergic reactions to the enzyme hyaluronidase are eliminated with:

• corticosteroid injections;
• adrenaline;
• antihistamines;
• when the pressure drops – drugs that constrict blood vessels.

A delayed allergic reaction to the enzyme hyaluronidase may appear within 24 hours as itchy redness or blistering that resolves on its own within a few days. Corticosteroid ointments may be used to relieve these symptoms.

Due to possible allergic reactions, an intradermal allergy test should be performed before the administration of the hyaluronidase enzyme. To do this, hyaluronidase is dissolved in saline and injected intradermally into the forearm. About individual sensitivity to  the enzyme hyaluronidase is evidenced by the appearance of any reaction – redness, itching, swelling – at the injection site.