What can I do to continue removal of biofilm/granuloma from Restylane SubQ? I had an allergic reaction to hyaluronidase.

Question

Nine years later the Restylane is encapsulated and probably biofilm or possibly Granulomas in my cheeks. I'm concerned that i have delayed allergic hypersensitivity to hyaluronidase during the treatment of granulomatous hyaluronic acid reactions. What can i do to continue the removal of the biofilm/granuloma? Please advise. This has become a nightmare.

Mitesh Kapadia, MD, PhD · Answer

The Hyalase formulation of hyaluronidase used in Europe is derived from animals and has a significant rate of allergic reactions. In the United States, we have Hylenex, which is human recombitant hyaluronidase and has a very low rate of allergic reactions. I suspect you will need to travel for treatment to a place where Hylenex is available. I would recommend contacting the Hylenex manufacturer to see where it might be available closer to home.

Nelson Lee Novick, MD · Answer

First, let me say that I am sorry that you are having this difficulty. A skin test to a human-derived variant of hyaluronidase would seem to be in order to determine whether hyaluronidase of any kind can be used. If this is not possible, or if you prove allergic to the aforementioned, the injection of anti-inflammatory agents, such as triamcinolone and/or 5-FU, may be tried. Additionally, or in lieu of this, the nodules may be physically broken up (to promote greater natural metabolic breakdown) via the use of subcision accompanied by saline injections. Make sure that you are consulting with a board certified physician with experience in the treatment of filler injection complications. Best of luck.

Dean P. Kane, MD, FACS · Answer

Dear Gilda66, This is a more complex problem if you have granulomas and hypersensitivity or low grade infection. After 9 years, I would expect the Restylane to have "dissolved" and you may be left with biofilm if you are still reactive. My best advice is to seek a University Hospital Chief of Dermatology consultation to reevaluate your concerns. Options may include: retesting to available hyaluronidase or acquiring a less sensitizing enzyme for injection. use of antibiotic, oral or intralesional steroid.I a mass persists, it maybe necessary to surgically remove it. I wish you the very best.

What can I do to continue removal of biofilm/granuloma from Restylane SubQ? I had an allergic reaction to hyaluronidase.

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