Hyaluronidase Risks

You state that hyaluronidase can more rapidly break down fillers in face. Does it break down natural acids in face, too? Can it cause perminant holes or scars in face? Is it FDA approved?

Doctor Answers 12

Hyaluronidase is not FDA-approved

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Hyaluronidase is an enzyme which accelerates the absorption of hyaluronic acid based dermal fillers. When used in small quantities it can help to smooth bumpy areas after cosmetic filler injection. When restricted to overfilled areas, the response can take a few days to be noticeable. It does not seem to cause any degeneration of the surrounding normal tissue when used in this manner.

It is not FDA approved for this purpose as no clinical trials have ever been conducted. This is an off label use for a drug which has been used for other purposes for decades.

Baltimore Facial Plastic Surgeon
4.9 out of 5 stars 36 reviews

Hyaluronidase side effects

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Hyaluronidase is an enzyme that is very useful in breaking down hyaluronic acid fillers such as Restylane, Perlane and Juvederm if and when too much filler is injected or a nodule develops. It is injected most commonly by a dermatologist or plastic surgeon directly into the nodule or overfilled area with minimal discomfort. Interestingly, it is very specific for the filler it is injected into and doesn't seem to affect the person's natural hyaluronic acid.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Hyaluronidase has been used for decades with minimal side effects

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Hyaluronidase is an enzyme that breaks down hyaluronic acid such as fillers used for cosmetic purposes like restylane, juvederm, perlane, etc. It doesn't seem to affect natural hyaluronic acid and has a predominate affect on filler injected. The reason for this is due to the fact that natural hyaluronic acid is found around a substructure within the skin. When natural hyaluronic acid is degraded it is reformed almost just as quickly. In fact, natural hyaluronic acid is turned over on a daily basis so your body naturally degrades its own hyaluronic acid and replaces.

With your natural foundation, the hyaluronic acid is formed all the time so the enzyme injected and its effects will be reversed quickly. It does not leave scars or holes, except in the area of previous filler injections. You have to be conservative in the amount that you use otherwise you can get depressed areas in the previous area that you augmented. That is the only temporary risk. Some suggest a skin test for the enzyme in case of an allergic reaction. But I know of hundreds to thousands of patients who ht tave received this in surgery centers with no issues at all.

Philip Young, MD
Bellevue Facial Plastic Surgeon

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Are there risks to my normal facial tissue from injected hyaluronidase to reverse hyaluronic acid gel filler ?

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The body naturally contains hyalurons in the extracellular matrix of connective tissue which are constantly being broken down by naturally occurring hyaluronidase. The process of production and breakdown of natural hyaluronic acid gel goes on all the time. 

When a synthetically manufactured cross linked hyaluronic acid gel as in dermal fillers is injected into the face, it will gradually breakdown over time, taking many months to disappear. If this breakdown or reversal is accelerated to be minutes by the injection of  hyaluronidase enzyme used medically off license by the physician, and with informed consent, it can conceivably cause temporarily break down a very small amount of the own body hyaluron.

Occasionally patients note that the area treated can look a little "deflated" the first day with the skin a little wrinkly, which improves rapidly as the natural hyaluronic acid gel is synthesised in its usual way. 

From: Miss Jane Olver, Consultant Oculoplastic Surgeon, LOndon, UK

Jane Olver, MBBS, FRCS
London Oculoplastic Surgeon
4.3 out of 5 stars 6 reviews

Hyaluronidase safety

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Hyaluronidase is used to dissolve products such as Juvederm and it does not seem to have untoward side effects as you describe. It works within 48 hours.and has been widely used in cosmetic practices.

Hyaluronidase can rapidly reverse the effects of hyaluronic acid fillers

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Hyaluronidase can rapidly reverse the effects of hyaluronic acid fillers. It is a very safe product and I have been using it for 15 years. I also use hyaluronidase for dispersing the effects of local anesthesia when I do eyelid surgery and it works very well. When used in small doses, it can quickly within 24-48 hours reverse the effect of the most common fillers such as Restylane and Juvederm. It has no visible effects itself and when the filler is gone, the net result will be a return to the pre-filler correction state. In even smaller amounts you can dissolve some of the excess filler while maintaining the correction; however, that is not always possible. I hope that information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Very safe despite off-label use

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The use of hyaluronidase to dissolve hyaluronic acid dermal fillers is very effective and safe. Although its use in this manner is not FDA-approved, this off-label use is very acceptable and beneficial. In fact, using HA dermal fillers anywhere besides the laugh lines (nasolabial folds) is also considered off-label but considered a standard of practice. We know of no adverse events as those suggested in the question.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Hyaluronidase can break down bumps from Juvederm and Restylane

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Hyaluronidase is great at smoothing down bumps from Juvederm or Restylane but may take a few weekly injections and doesn't affect the normal skin at all so it has no permanent problems with regular use.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

Hyaluronidase risks

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Hyaluronidase is a very safe injectable that can reverse the effects of hyaluronic acid based dermal fillers.  I would recommend that you only visit with an experienced plastic surgeon or dermatologist injector as this is a very nuanced injection technique.  It can be fairly rapid in onset and will not effect the tissue surrounding the injectable filler.  More often, a patient is not asking for complete reversal but rather to address specific concerns associated with their prior injection.

Hyaluronidase side effects

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Hyaluronidase is FDA approved to help anesthetics spread when injected into the skin and various areas. It should not create a permanent effect. There has been a case report of a patient having an allergic reaction to hyaluronidase as it is porcine or bovine derived. This is one case report in the literature and it is injected every day thousands of times so I would say it is a very safe medication. 

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.