Dissolving hyaluronic acid with hyaluronidase: expert recommendations

Cosmetologist Sharon Bennett on the rheological properties of HA fillers, which must be taken into account when introducing hyaluronidase:

“ Hyaluronidase is a substance well known to cosmetologists, which is used off-label to dissolve dermal fillers based on hyaluronic acid.

Injections of this enzyme are used both to correct the aesthetic result and to resolve serious complications after the administration of HA.”

In this article estet - portal . com presents the results of an experiment conducted by cosmetologist Sharon Bennett to demonstrate the reaction of different hyaluronic acid gels to hyaluronidase.

• Dissolution of HA with hyaluronidase: recommendations of the expert group
• Interaction of hyaluronic acid fillers with hyaluronidase: an experiment by the author
• What factors are important to consider when working with hyaluronidase? th

Dissolution of HA with hyaluronidase: recommendations of the expert group

The dose of hyaluronidase required to dissolve hyaluronic acid, according to the guidelines developed by the Expert Complications Panel (ACE), depends on several factors and characteristics of the filler, such as:

• mono- or two-phase gel;
• degree of cross-linking of HA;
• HA concentration.

However, the manual does not explain exactly how the different properties of the filler affect its degradation.

The group of experts recommends not focusing on a specific dosage, but administering the amount of hyaluronidase that is necessary to obtain the desired effect.

Generally, practitioners report that much more hyaluronidase is needed than indicated in the manual to obtain the desired result (Table 1) .

Table 1: ACE Group recommendations for the amount of hyaluronidase to dissolve fillers in various anatomical areas of the face.

A recent (2018) study analyzing the interaction of three HA fillers with hyaluronidase (Hylase) found that:

• filler with the maximum HA content is most resistant to degradation;
• monophasic and biphasic gels are equally sensitive to the enzyme;
• The higher the degree of cross-linking of HA, the more resistant the filler is to degradation.

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Interactions of hyaluronic acid fillers with hyaluronidase: an experiment by the author

The author notes that the experiment conducted is not an official study and certain restrictions apply to its results, since:

• the doctor did not analyze the differences in the properties of fillers and their potential impact on interaction with hyaluronidase;
• exposure time was limited to 5 minutes;
• the experiment was carried out once.

The author chose 4 different brands of HA fillers that are used to correct the lips (since complications in this area, requiring the injection of hyaluronidase, occur most often).

Features of hyaluronic acid removal: important information for specialists

Different particle sizes, cohesiveness, and cross-linking methods of HA may cause different filler responses to hyaluronidase.

Progress of the experiment:

1. Each of 4 fillers in an amount of 0.2 ml was applied to the mirror surface (Fig. 1) .
2. 1500 units hyaluronidase ( Hylase ) was diluted with 5 ml of saline solution; thus, in 1 ml of solution = 300 units. enzyme, and 0.1 ml of solution = 30 units. enzyme.
3. 30 units were injected into every 0.2 ml of filler. hyaluronidase.
4. After 5 minutes, the results were obtained (Figure 1 and Table 2) .

Rice. 1: Four HA fillers (0.2 ml each) before and 5 minutes after injection of 30 units of hyaluronidase.

Table 2: Filler response to hyaluronidase.

What factors are important to consider when working with hyaluronidase?

The experimental results confirm that different HA-based products react differently to hyaluronidase.

And this, in turn, affects the amount of time required to eliminate a particular complication, which is especially important in emergency situations.

Degradation of fillers that break down into large particles or clumps requires more hyaluronidase or repeated injections of the enzyme.

As is known, with repeated injections:

• the risk of inflammation, bruising and tissue injury increases;
• high doses of hyaluronidase are associated with risks of allergic reactions.

Hyaluronidase enzyme in cosmetology: eliminating side effects of fillers

However, in emergency situations, high doses of the enzyme are simply necessary.

Thus, according to the High-Dose Pulse Hyaluronidase (HDPH) Protocol included in the ACE guidelines, in the case of tissue ischemia , it is recommended to administer 450–1500 units. hyaluronidase every hour until the complication resolves.

It is important to understand that the dose of hyaluronidase required to resolve the complication may be significantly higher than that indicated in the recommendations and vary depending on the filler injected.

The author believes that large-scale studies are needed on the interaction of HA fillers with hyaluronidase, which will provide practitioners with information about the amount of enzyme and the time required to dissolve various drugs.

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