Could Hyalase Dissolve Fat?

Question

I had a lot of Hyalase injected (at a very strong dose, many times over several weeks) and ended up with quite hollow undereyes. Could Hyalase have dissolved fat? I know that the standard answer is no. But is it possible?

Daniel Ezra, MD, FRCS · Answer

It is a widely held misconception amongst doctors that hyalase is a benign treatment. remember that Hyaluronic acid is a natural constituent of the connective tissues around the body (extracellular matrix). If heavy doses are given, it can dissolve the natural connective tissues of the face, particularly the delicate areas under the eyes. I am seeing a great many patient in my clinic for filler complications who have been further damaged by heavy hyaluronidase treatment. This 'post hyaluronidase syndrome' gives a hollow and gaunt look, sometimes with darkened skin.
Doctors need to ensure that they go easy with the dosing and use high dilutions.

Camille Cash, MD · Answer

Hyaluronidase is an enzyme to target hyaluronic acid specifically.  It should not dissolve fat.  I encourage you to discuss your concerns with your injector as well as compare before and after photos of your treatment to determine what may be occurring.

Jason Emer, MD · Answer

This is difficult to answer without pictures. Hyaluronidase has no impact on normal skin and shouldn't cause volume loss. I recommend getting a formal evaluation with a cosmetic dermatologist to evaluate cause and treatment options. Best, Dr. Emer

Ramandeep Sidhu, MD · Answer

Good question. Hylase typically doesn't dissolve fat. Now if you had high dose and several injections it can cause significant inflammation and once that heals can leave behind the hollow effect but typically it doesn't dissolve fat.

Sheryl D. Clark, MD, FAAD · Answer

Dear matthowes:Thank you for your question! I can tell you that hyaluronidase (Vitrase, Hylenex) is an enzyme that is specific to hyaluronic acid only, just as deoxycholic acid (Kybella) is specific to fat. It is impossible for Hylenex (or Kybella) to dissolve any other substrate than hyaluronic acid (or fat, in the case of Kybella). As you know form your chemistry classes, enzymes, like hyaluronidase, usually are specific to one chemical reaction only, and that is the case with hyaluronidase. I hope that your dermatologist or plastic surgeon can help you to understand what is going on with your undereye area. All the best, Dr. Clark

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Could Hyalase Dissolve Fat?

Answers (5)

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