Hyaluronic acid injections are currently very widely used in aesthetic medicine, as they can be used to solve a number of problems. Hyaluronic acid fillers allow you to fill in missing volumes, correct contours and even eliminate wrinkles.
However, in the practice of each specialist performing hyaluronic acid filler injections, there are situations when, for one reason or another, it is necessary to remove the drug from the tissues. Irina Morozova, a dermatovenereologist, cosmetologist, founder of the Harmony of Beauty Center for Injection Cosmetology, Dnipro city, spoke about the specifics of hyaluronic acid removal in an exclusive interview for estet-portal.com.
Irina Morozova about the features of hyaluronic acid removal
In what situations, most often, the patient needs to undergo hyaluronic acid removal
I.M. We love hyaluronic acid very much, but we also remove it all the time, especially when we have to treat complications.
Complications can occur even in the most experienced doctor, but the doctor in this case quickly diagnoses and prescribes treatment, so the outcome is usually favorable. But today, unfortunately, cosmetologists without medical education are also engaged in aesthetic medicine, in which case the patient is left alone with a complication, he is fed with promises that he has to wait.
Precious time is lost, and this is the worst thing, such patients usually seek help in a neglected state, and this significantly affects the result of treatment.
Hyaluronic acid removal is performed in several cases.
The first option when it is necessary to remove hyaluronic acid – these are emergencies when it comes to arterial embolism with hyaluronic acid.
This, unfortunately, happens, and then assistance should be provided to the patient immediately on the couch, that is, hyaluronidase should be immediately introduced in order to remove the embolus and restore tissue microcirculation. That is, hyaluronidase is injected when hyaluronic acid must be eliminated immediately to restore tissue vitality.
The second option is when hyaluronidase is injected for aesthetic reasons, to eliminate technical errors in the introduction of fillers, when they are injected incorrectly, superficially, in lumps or in large quantities. In such cases, we either completely eliminate the hyaluronic acid filler, or partially correct only those areas that are aesthetically unacceptable.
Working protocols for hyaluronic acid removal
Working protocols for hyaluronic acid removal are either full or partial filler removal. For example, in order to remove 1 milliliter of hyaluronic acid filler, we need from 300 to 1000 units of hyaluronidase, and sometimes even more. Such a large run-up exists because our fillers are very different. For example, sometimes even more than one hyaluronidase injection is needed to remove long-acting drugs.
Or in the case of ischemia, when we inject hyaluronidase several times so that it can still penetrate inside the arterial vessel and eliminate the hyaluronic acid that is located directly inside the artery. And since Hyaluronidase does not penetrate very quickly through the wall of the artery - a series of injections of hyaluronidase is carried out.
Partial removal of the hyaluronic acid filler with hyaluronidase is performed, for example, when we remove only the superficial part of the filler, or reduce the overcorrection area.
In this case, we need to decide on the units of hyaluronidase. As a rule, this is a small job units, from 6 to 60 units of hyaluronidase, the introduction of which is necessary in order to eliminate only the “tip of the iceberg”, and the rest of the filler remains.
That is, we usually use two protocols for removing hyaluronic acid: when we remove the filler completely, or when we “grind” it, that is, remove it partially.
Important rules for removal of hyaluronic acid
I.M. The doctor must decide which hyaluronidase he will work with, recombinant or animal hyaluronidase. Allergic reactions to recombinant proteins are much less common than to animal proteins. Once upon a time, insulin was of animal origin, and patients suffered from allergic reactions, but everything changed as soon as recombinant insulin appeared.
We remove hyaluronic acid when there are certain indications for it, for example, when you don’t like the result to the patient, or when the doctor, by palpating the tissues, determines the lumps of the filler and fibrous changes in the soft tissues.
The doctor must understand what he is doing, how and why he is doing it. It is necessary to determine the dose and frequency of administration of hyaluronidase.
Does the patient need rehabilitation after removal of hyaluronic acid
I.M. Special rehabilitation is not needed. After the procedure, the patient will have nothing but a slight edema, unless, of course, it is recombinant hyaluronidase. The swelling goes away on its own within a few hours.
As a rule, immediately after the procedure, the doctor performs a massage on the patient so that hyaluronic acid and hyaluronidase find each other as much as possible.
After the procedure, we can recommend that the patient also perform tissue massage at home.
Is there a need to prescribe special studies before removing hyaluronic acid
I.M. Sometimes we order soft tissue ultrasound when it is necessary to understand what drug it is, because patients very often come and do not know what drugs they need were introduced. Hyaluronidase affects only hyaluronic acid, and if we doubt what exactly was injected into this patient, or the patient himself does not know whether he was injected with hyaluronic acid or something else.
Read also: Hybrides with hyaluronic acid: the future of aesthetic medicine
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