Hyaluronidase Caveats in Treating Filler Complications.

Landau M.Dermatol Surg. 2015 Dec;41 Suppl 1:S347-53. doi: 10.1097/DSS.0000000000000555.PMID: 26618463

Abstract: Background: Most of the complications associated with hyaluronic acid (HA) fillers can be addressed by hyaluronidase. Extensive experience with this enzyme has been accumulated in ophthalmology and anesthesia. In dermatological use, many aspects still remain controversial.


Objective: To clarify questions about the use of hyaluronidase in complications caused by HA, including the appropriate dose, timing and delivery technique, differences in the activity of hyaluronidases of different origins, the interaction between enzymes and different HA gels, and issues of security.


Materials and methods: An extensive review of relevant literature was performed. The conclusions are based on this review and the author's personal experience.


Results: FDA-approved hyaluronidases provide predictable results and can be used interchangeably. A physician should be intimately familiar with the specific characteristics of other hyaluronidases. Different brands of HA fillers have different sensitivities to degradation by hyaluronidase. For overcorrection or misplacement of the filler, a low dose of enzyme should be injected directly into the visible HA mass. In case of vascular accident, irrigation of the ischemic area with high doses of hyaluronidase is required. Hypersensitivity reactions to hyaluronidase have so far not been reported in the dermatological literature.


Conclusion: With the increasing popularity of HA fillers, hyaluronidase had become an indispensable tool in the dermatology office. It is safe and reliable for treating complications caused by HA.