Does Hyaluronidase Always Work in Dissolving Restylane?

Are there any times why Hyaluronidase will not work to dissolve Restylane?

Doctor Answers 1

Hyaluronidase for dissolving fillers

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On a basic biochemical level, the answer is yes, it will dissolve hyaluronic acid fillers. It is specifically the enzyme required to begin it's degradation. However other elements will influence the way a body responds.

One, response is in part dose dependant. A number of studies have shown more rapid degradation or more complete clinical response with higher doses of hyaluronidase. So an incomplete response may be due to a dose that was too low.

Two, it clearly has to reach the filler in question. H'dase is well known for its ability to disperse through tissue, so it can cover some distance from it's injection site. But it has to be close enough to the filler in question to be effective. Or not sequestered from the filler in question by a normal anatomic structure like the orbital septum for periorbital injections or scar tissue.

Three, other soft tissue effects may still be causing fullness to an augmented and reversed region. Normal swelling, minor soft tissue response to the filler or the needle may still leave a little fullness. Or it may be your own collagen (a recent publication using staged injections of restylane showed new collagen growth in the region of injection when reevaluated 18 mos later). Most docs see a little of this phenomena after two or three serial injections in the same tissue.

Finally, it is not unheard of to have a reaction to h'dase. This should show up with redness along with swelling, though, so should be fairly easy to differentiate from an incomplete response.

Hope this helps

Madison Facial Plastic Surgeon
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