How many units of Hylenex to dissolve 1/2 syringe of filler? (Photo)

Most injectors really don't understand the filler and their physical characteristics. They also don't understand the use of the enzyme. Runny fillers like Restylane Refine and Define need much more enzyme to remove than high G prime fillers like Restylane or Lyft. Restylane Refine was an effort to make a filler like Juvederm. The marketers call these products "smooth." That is marketing speak for runny. These low G prime fillers diffuse far and wide. They are very much not appropriate for the under eye area in my opinion. Belotero is the runniest of the product. So much so, that Belotero does not concentrate any where enough to make Tyndall. To remove these runny filler, much more enzyme must be used to remove the filler. The most I have used on a single patient is 1500 Units. That is 10 vials of 150 units of Hylenex. The skin looks wrecked after a bad enzyme service because much filler is left in the skin. The skin looks boggy. That is not because your natural hyalurnonic acids are damaged. It is because you have unremoved filler. Don't take hope away from people because you have received bad care. You need to find the right doctor.

The amount of Hyaluronidase required  depends on a number of factors and just like with any other procedure, is adjusted to fit the problem.  As a general rule the best person to dissolve filler is usually the person who placed it  since they presumably know the exact anatomic location where it was placed. No amount of Hyaluronidase will dissolve filler if it is not placed in the same plane (same tissue level) as the filler. Also, even for hyaluronic acid fillers, some fillers are more easily dissolved than others depending on various properties of the particular filler. Some fillers are also best used or avoided in certain areas of the face. Unfortunately, it is not quite like a pencil and eraser. 

The amount of hyaluronidase to be used depends on the experience of the surgeon who is treating you as a patient. there are different concentrations of hyaluronidase available on the market so the doctor should know how much should be used on you. two or three treatments may be necessary for many patients for optimal results as you don't want to use too much hyaluronidase because it may cause disappearance of natural tissues. Good luck from New York City

Thank you for your question. Hyaluronidase(Wydase) is often used to degrade HA filler that have been injected and specifically cross-linked to prevent their natural breakdown.The dosage required is dependent on several factors relating to the HA filler; whether it is particulate or non-particulate, the amount of cross-linking, and the concentration of HA. Different HA fillers have differing physical properties that influence their degradation by hyaluronidase in a time- and dose-dependent manner.  A recent study has shown that Belotero was the fastest to dissolve and Juvederm Voluma®  and Restylane®Lyft were the slowest,  concluding that hyalronic acids with a high concentration of HA, larger particle size, and increased cross-linking increases the durability of the filler.
The literature and my experience sggest many different doses . I usually start with .2 to .5 and then I inject as much hyaluronidase as required to obtain the desired effect rather than following an absolute dosage. So the the amount injected should be titrated to clinical effect.

I hope that helps
Gail Humble MD

A good rule of thumb for hyaluronidase dosing is 1 vial of hyaluronidase for 1 mL of filler. Hope this helps.