HealthCert Blog

Hyaluronic acid (HA) dermal fillers are routinely used in aesthetic medicine today. They are the most popular non-surgical, minimally invasive treatment for the lack of skin volume and the resulting aesthetic issues, such as:

• Wrinkles and fine lines
• Deep creases
• Facial folds
• Insufficient volume of the lips, jawline, or other facial contours

Complications with this procedure are rare. They also vary in severity, from an undesired cosmetic outcome to allergic reactions or blindness. Addressing these complications with Hyaluronidase is usually the first choice of practitioners in primary care.

What is Hyaluronidase?

Hyaluronidases are enzymes. In humans, there are five functional ones (HYAL 1 to 5) and one non-functional, the HYAL6. These enzymes can degrade hyaluronic acid. They boost HA’s dispersion and delivery to the tissue by lowering its viscosity and increasing tissue permeability.

Such properties make Hyaluronidase extremely useful in aesthetic medicine when complications with HA injections occur.

Potential side effects of hyaluronic acid dermal fillers

The aesthetic treatment with hyaluronic acid dermal fillers should take place only in a controlled environment. The procedure is simple, and the recovery is fast. So, with adequate and high-quality training, primary care workers can successfully administer HA injections.

We can divide potential side effects into two groups:

1. Common side effects, and
2. Rare side effects

Common side effects are mild and can appear even when the procedure is flawless. They include:

• Redness
• Bruising
• Swelling
• Itching
• Pain

These side effects usually resolve on their own after several days.

Rare side effects include:

• Infections
• Formation of granulomas and nodules
• Leakage or movement of the filler
• Vascular occlusion
• Tissue necrosis
• Blindness
• Allergic reaction

Such side effects usually appear because of a non-sterile environment or equipment, inadequate training, and poor treatment technique. They can have severe and permanent consequences.

Hyaluronidase indications

In most cases, rapid Hyaluronidase application in primary care can reverse some complications and prevent further damage to the patient’s health. The injections have an immediate effect and remain effective for 24 to 48 hours after application.

Common indications for Hyaluronidase use include:

• Unacceptable aesthetic outcome
• Tyndall effect
• Delayed onset nodules
• Vascular occlusion
• Blindness
• Allergic reaction

Administration and dosage

Hyaluronidase comes as a sterile and ready-to-use solution. It is odourless and colourless.

Proper administration of injections is: intramuscular, interstitial, intraocular, retrobulbar, subcutaneous, or into soft tissue.

Intravenous injections are ineffective because such application leads to rapid inactivation of the active component.

A typical dose is 150 to 200 units of Hyaluronidase with 2 to 4 millilitres of diluent.

Possible complications

Allergic reactions are rare. They occur in less than 0.1% of patients.

Mild side effects happen around the injection site. These include:

• Inflammation
• Bruising
• Swelling, and less commonly
• Oedema

Interactions with other medications are possible. Hyaluronidase may enhance the side effects of co-administered drugs. Benzodiazepines, furosemide, and phenytoin are incompatible with Hyaluronidase.

Follow-up

A follow-up after Hyaluronidase injections depends on the type of complication. Some reversible adverse effects of dermal fillers, such as the Tyndall effect and unacceptable aesthetic outcome, only require monitoring, while others demand further treatment.

For example, delayed onset nodules require antibiotics before Hyaluronidase application to prevent the spreading of the infection.

Severe complications, such as blindness, vascular occlusion, and cutaneous necrosis often require a comprehensive treatment approach beyond the reach of primary care.

Learn more with the Certificate Courses in Aesthetic Medicine

Read more recent research.

References

• Ciancio F, Tarico MS, Giudice G, Perrotta RE. Early hyaluronidase use in preventing skin necrosis after treatment with dermal fillers: Report of two cases. F1000Res. 2018 Sep 3;7:1388. doi: 10.12688/f1000research.15568.2. PMID: 31001410; PMCID: PMC6449787.
• Buhren BA, Schrumpf H, Hoff NP, Bölke E, Hilton S, Gerber PA. Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Eur J Med Res. 2016 Feb 13;21:5. doi: 10.1186/s40001-016-0201-5. PMID: 26873038; PMCID: PMC4752759.
• Cavallini M, Gazzola R, Metalla M, Vaienti L. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J. 2013 Nov 1;33(8):1167-74. doi: 10.1177/1090820X13511970. Epub 2013 Nov 6. PMID: 24197934.