If you are unhappy with your past dermal filler results due to unevenness, lump, migration or if you are looking to dissolve past injection in general, hyaluronidase injections may be a solution for you. Hyaluronidase may also be injected if you experience an allergic reaction to hyaluronic acid (HA) dermal fillers.
One of the benefits of hyaluronic acid (HA) based dermal filler is that the effects of the treatments are entirely reversible through the use of hyaluronidase. They can be easily reversed via this dissolving process at any later date, even months down the road.
Hyaluronidase is an enzyme solution that is marketed with several FDA-approved brand-name formulations, including Hydase, Hylenex, Amphadase and Vitrase. Hyaluronidase is injected into the same area of the tissue as the hyaluronic acid product (Juvederm, RHA, Restylane, Belotero) was injected previously. Hyaluronidase injections are used to break down or reverse these products and works fairly quickly, usually within 24 hours. Sometimes it may be necessary to return for a second or third injection. It does not work on non-hyaluronic fillers, such as Radiesse or Sculptra.
How much Hyaluronidase is needed to dissolve filler?
The amount of hyaluronidase in a hyaluronidase injection varies widely depending on the current amount of hyaluronic acid filler in the treatment area, the type of hyaluronic acid filler, and the desired outcome of the hyaluronidase treatment. Particularly in the case of hyaluronic acid fillers that use cross-linking technology to delay its natural breakdown, more hyaluronidase may be needed. Additionally, whether the filler is particulate or non-particulate, and the concentration of hyaluronic acid within the formulation of the filler can affect the recommended amount of hyaluronidase.
How long does it take for Hyaluronidase to work?
The effects of hyaluronidase will begin to appear immediately after a hyaluronidase treatment has taken place. However, the amount of time it will take for the full affect of hyaluronic acid filler reversal varies depending on the individual patient. The majority of patients see complete results from hyaluronidase injections over the course of a few days, though some may need two to three weeks in order to observe the full effects of the treatment.
After the hyaluronidase takes full effect, some patients may feel that they’d like to boost their collagen production through alternative means aside from dermal fillers. In this case, we can help to develop a revitalizing skincare treatment plan, which can range from laser resurfacing to chemical peels to microneedling.
Who is it suitable for?
Anyone who has previously had Hyaluronic Acid based fillers injected. We cannot dissolve semi or permanent fillers, these will need to be removed surgically. Dissolving is unsuitable for pregnant or breastfeeding women.
Is Hyaluronidase safe?
Yes, like Juvederm and Restylane, it is safe to inject hyaluronidase, and side effects are rare. That said, you could potentially look at testing it gradually via multiple treatment sessions. Unlike procedures that use alternative non-hyaluronic-acid substances such as Radiesse, Sculptra or silicone oil fillers, hyaluronic acid fillers can be re-shaped immediately after the procedure is done, or months later.
Does Hyaluronidase have any side effects?
Side effects to hyaluronidase are both rare and uncommon. The most likely side effect of hyaluronidase is mild allergic reaction near the injection site, with a reported incidence of between 0.05% to 0.69%. Recent studies have shown that hyaluronidase is antigenic, which means that repeated hyaluronidase injections of relatively large may lead to the production of neutralizing anti-bodies. This means that Hyaluronidase will not necessarily continue to be as effective in dissolving hyaluronic acid filler with large amounts of use. Additionally, it’s good to note that hyaluronidase should not be injected via intravenous injections, as this can put patients at risk for allergic reactions and more severe side effects.
Occasionally, patients may observe a “depleted” look due to a temporary dip in the natural hyaluronic acid stores within the body. However, in this case, your natural hyaluronic acid will return to normal over the course of a few hours to a few days. If, after several weeks, your skin continues to appear depleted or sagging, we can help to stimulate collagen production within the body to offset these undesirable effects. We can work with you to develop a customized restorative treatment plan. Collagen stimulating treatments include laser resurfacing, microneedling, and chemical peels, among others.
How will I know I’m not allergic? We will carry out a small, painless patch test, usually on the forearm 15-30 mins prior to procedure. You will then be closely monitored to check for any signs of allergies. If there are no signs of allergy we can then safely proceed with treatment. Please note due to the single use sterile vial, if you are allergic after a small dosage of enzyme following the patch test, full payment is necessary and will be taken prior to procedure.
How long after removing my previous filler do I have to wait before I can receive a refill? We require a minimum of 2 weeks between removal of previous filler by dissolve and refill with our injectors.
What does Hyaluronidase cost?
The cost of hyaluronidase varies based on how much treatment is required and the areas affected. We can provide a quote based on consultation, but the average treatment ranges from $500 and up. Your practitioner will be sure to carefully assess your concerns due to hyaluronic acid filler, and provide you with a treatment plan that best fits your budget and individual needs.
Please not due to the single use sterile vial, if you showing signs of an allergic reaction after a small dosage of enzyme following the patch test, full payment is still necessary and is always taken prior to procedure, as we then have to dispose of the Hylaronidase as it cannot be used on anyone else.
Contraindications include but are not limited to the following:
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- Pregnancy or breastfeeding
- Skin cancer or suspicious lesions
- Poorly controlled medical conditions
- Allergies to local anesthetics
- Hypersensitivity to hyaluronidase or any other ingredients in the formulation
- Patients taking furosemide, benzodiazepines, phenytoin, dopamine and/or alpha agonists
- Impaired immune system and/or use of immunosuppressive medications
- Patients with unrealistic expectations
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Compliance with the recommended pre / post-care instructions as well as recommended follow-up visits by your practitioner are crucial in minimizing the risk of side effects and complications. It is your responsibility to inform your practitioner of your most recent sun exposure, new medications, or changes in medical history before each treatment is performed.
Before your treatment
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- Alcohol, aspirin, Ibuprofen and a range of dietary supplements including; St. Johns Wort, Omega 6 oils, Garlic, Gingko Biloba, Vitamins C and E-supplements may all contribute to bruising and are best avoided 5 days before treatment.
- Treatment cannot be administered if there is an active skin infection, including acne or cold sores or if you are unwell- including colds, coughs, sore throats etc. Do contact the clinic to discuss any illness or new medicines prior to attending.
- If you are receiving the treatment to correct unsatisfactory results, you will be given a test dose (a small injection on your forearm) and observed for a minimum of 20 minutes, to identify any sensitivity which may indicate allergy to Hyaluronidase. If symptoms of sensitivity are observed then treatment cannot proceed.
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Day of Procedure
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- Arrive with clean skin free of any lotion, oil, makeup, powder, or sunscreen.
- Notify your practitioner of any changes in your medication, or health status, or personal activities that may be relevant to your treatment.
- Topical numbing cream or small lidocaine injections may be administered to maximize your comfort during the treatment.
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After Your Treatment
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- Most people are able to continue with normal activities with immediate improvement in their appearance. Some will have some redness, pin prick marks, possibly swelling- particularly in the lips. Possibly bruising. Any swelling and bruising may be more apparent the next day.
- Makeup should not be worn for 12 hours
- You are advised to vigorous exercise, sun bathing, and extremes of heat or cold for 14 days post treatment. These activities have been found to increase and prolong swelling.
- Swelling may worsen in the first 24 hours, and then settle within the first few days. Cold packs can be helpful in reducing swelling. Due to swelling, and the action of the Hyaluronidase you may notice some asymmetry. The final result may be assessed at 2 weeks.
- Bruising may take a few days to appear, arnica can be helpful in clearing bruising. It is advisable to avoid aspirin and alcohol for 12-48 hours after treatment. Tenderness should settle as swelling goes down.
- Please contact your practitioner if redness, tenderness, itching or swelling worsens after 3 days, rather than settling.
- Hyaluronidase is an enzyme which breaks down hyaluronic acid fillers, but it can also break down naturally occurring hyaluronic acid present in the body. The results can be unpredictable and the effect dramatic with possible loss of volume and some skin laxity. Although some of the effects can be immediate, it can take up to 2 weeks for the final results to be seen and the procedure may need to be repeated. Any over correction resulting from the loss of your own hyaluronic acid will usually be temporary and is expected to recover within a few days. The breakdown of the dermal filler will be permanent.
- Hyaluronidase administration can result in anaphylaxis (a severe allergic reaction) which in itself is life threatening and requires immediate medical attention. Symptoms of a severe allergic reaction can include shortness of breath, wheezing, coughing, difficulty swallowing, swelling of the tongue, eyelids, lips, hoarseness of the voice, stomach pain, nausea or diarrhoea. If you have any of the above symptoms please report to your nearest Accident and Emergency Department or call 911.
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If you experience any side effects, such as prolonged discomfort or swelling, or infection, immediately contact your practitioner for proper assessment and care instructions.