What are the risks of hyaluronidase?

Question

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?

Ira D. Papel, MD · Answer

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.

Anil R. Shah, MD · Answer

The main risk with hyaluronidase includes the possibility of reducing normal tissue instead of just filler.  The key is to use an appropriate concentration of hyaluronidase and seek an experienced injector.  Best Dr. Anil Shah

Young R. Cho, MD, PhD · Answer

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.

William Ting, MD · Answer

Hyaluronidase is officially approved by the FDA to improve the dispersion and absorption of other drugs, such as anesthetic agents. The use of hyaluronidase to reverse hyaluronic acid fillers such as Restylane, Juvederm, or Perlane, while safe and effective, is not officially approved by the FDA and thus is considered an off-labelled indication. Ideally, allergy testing should be performed along an inner forearm area and observed for 24-48 hours to minimize risk of very unlikely chance of allergic reaction.

Harold J. Kaplan, MD · Answer

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.

David Hansen, MD · Answer

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.

Scott Trimas, MD · Answer

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.

Dmitriy Schwarzburg, MD · Answer

Hyaluronidase is designed to dissolve fillers made of hyaluronic acid. If you are not satisfied you can always have it dissolved. Bruising, swelling, or discoloration are possible side effects but they normally disappear in a couple hours or so. Please contact a qualified provider or a board-certified physician with extensive experience in these procedures.

Maria Milone, MBBS · Answer

Hyaluronidase is not TGA( in Australia )or FDA( in the USA) approved for removal of hyaluronic acid based filler but is used off label for this purpose . It does break down some of the bodys natural hyaluronic acid but this quickly regenerates .Thus some temporary dehydrated look to the  skin is observed in the first couple of days which is more than just the filler being dissolved.It does not cause holes in the skin or permanent scarring .

Monika Soni, MD · Answer

Thank you for your question. No, hyaluronidase does not cause degeneration of surrounding tissues or cause scars. Hyaluronidase is an enzyme that helps break down hyaluronic acid dermal fillers and in small quantities is used to help smooth out bumpy areas after injection. I recommend contacting your injector with any concerns that you may have. Best of Luck!

What are the risks of hyaluronidase?

Answers (16)

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