Can hyaluronidase decifer between filler(Restyln) and natural hyaluronic acid found in soft tissue and skin?

I'm under the impression my natural hyaluronic acid has been affected to some degree in the process of dissolving restyln in my under eye, lower eyelid area. I now have crepe, sagging skin, loss of volume, lines and wrinkles that were not there a month ago. The only change in the month was injections of Restyln and hyaluronidase. Does the skin go back to before the hyaluronidase was injected? What would you recommend to help my under eye area? Any natural remedies, any input would help Thanks

Doctor Answers 9

Crepey Skin Solution

You're right, it would not be able to differentiate. It will take a few months for you to go back to your "normal". However, fillers, lasers, and microneedling/PRP can improve the under-eye area. See an expert. Best, Dr. Emer


Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Hyaluronidase will breakdown both injected and natural hyaluronic acid

Dear searcher21:

Good question!

The simple answer is no. 

Hyaluronidase is one of a group of animal derived and recently human enzymes developed for many different actions associated with the enzymatic breakdown of the hyaluron molecule. Hyaluron is the basic molecule used in making the hyaluronic acid (HA) gels used in filler injectables. 

Hyaluron is synthetically linked to add to the unique features producing the hyaluronic acid fillers and both endogenous (your personal enzyme) and exogenous (that injected) hyaluronidase is able to enzymatically breakdown both injected filler and natural human hyaluronic acid. 

Depending on the product, dilution and injection technique, the outcome of hyaluronidase can breakdown less or more than the injected HA product. 

Other options to re-injection of HA fillers include: 

  1. Sculptra
  2. Obagi ZO Skin Health using retinoids and chemical peels 

 I hope this has been helpful. Please consider consultation with a artsy, talented and skillful Board Certified Plastic Surgeon with experience in injectables, non-surgical and surgical techniques. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 70 reviews

Hyaluronidase

Excellent question. Hyaluronidase is an enzyme that acts on hyaluronic acid and cannot distinguish between your natural HA and that that was injected so your observation is correct.Over time your body will replace the HA and you can have more injections of HA into the area

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Hyaluronidase effects

Hyaluronidase cannot differentiate between your own hyaluronic acid and those found in fillers. However, your body constantly produces this material, so, over time, anything lost from the dissolving injection, should be replaced. I would wait a few months and see if the situation resolves itself before seeking treatment.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Hyaluronidase

Hyaluronidase specifically breaks down filler material. It should not impact your natural hyaluronic acid n your tissues.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Hyaluronidase Can Dissolve Both Natural & Injected Hyaluronic Acid

Hyaluronidase is the enzyme responsible for the metabolic breakdown of hyaluronic acid, whether naturally occurring or injected in the form of a filler. This means that the crepeyness, crinkles, lines and sagging that you are now complaining of may very well be from both the loss of the injected Restylane as well as the natural hyaluronic acid in this region. Happily in a few months, the area will return to normal as your normal synthesis replenishes much of what you naturally had present prior to your treatment. 

However, your question raises some important issues. For one thing, straight Restylane is not used much by experienced injectors for treating the area under the eyes because of its propensity for leaving bumps, nodules and, if injected too superficially, even resulting in the unwanted, grayish-bluish Tyndally Effect. Instead, diluted Restylane was used and more recently Restylane Silk. In my Upper East Side Manhattan practice, I personally prefer Belotero Balance, and in my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available, my choice is Teosyal Redensity II. The second point is that the under eye region is not a region to be left to novice injectors trained only to inject plain Restylane into ordinary smile lines. Injection the delicate region under the eyes is an advanced injection technique that should be left to experienced injectors only. So, going forward, be sure to seek out care by a board certified, aesthetic core physician and make certain to ask to see his/her before and after photos. Good luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 24 reviews

Can hyaluronidase decifer between filler(Restyln) and natural hyaluronic acid found in soft tissue and skin?

Natural hyaluronics in the skin are dissolved by Hyaluronidase. These substances are metabolized naturally in skin and other tissue,   go away and are reformed within days.

If you dissolve natural HA away,  it  should reconstitute in a few days, maybe a week. What you describe is not normal. I have done this many times over  more than a decade and not seen this reaction  You have to make sure that Hyaluronidase was in fact what was used and not steroids. What you describe is a reaction seen with steroid injection.  

People also forget how they looked, I would corroborate you observations with the photos.

Val Lambros, MD, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 8 reviews

Can hyaluronidase injection to dissolve the Restylane filler affect the natural hyaluronic acid in your skin

The injection of hyalase is done directly on to the filler and is typically not known to affect the normal Hyaluronic acid in the surrounding tissue.

 Hyaluronidase injection is  also very commonly used along with local anesthetics to provide periorbital and retrobulbar blocks during eye surgery.

My opinion would be to discuss the options of skin tightening procedures for under the eye area or platelet rich plasma with your physician.

Best Wishes Dr. Shanthala

Hyaloronidaze

hyaloronidaze will dissolve both your own natural HA and injected restylane, however, the body quickly rebuilds lost hyaloronic acid. For crepy skin around eyes try retinol products, fractional laser or micro needling.alternatively, you can give fillers another try. I would opt for a very "thin" filler such as belotero, injected deep under the muscle with a microcanula, by an experienced injector. Best of luck!

Neda Vanden Bosch, MD
West Palm Beach Physician
5.0 out of 5 stars 9 reviews

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.