Signed in as:
Signed in as:
Hyaluronidase is a soluble protein enzyme that is typically used to break down the hyaluronic acid found in dermal filler. The solution works by breaking up the bonds that hold the HA molecules together— and encourages the body to reabsorb those molecules in a natural process.
Hyaluronidase gets to work immediately over the course of 24 to 48 hours. Once we start the process of injecting the hyaluronidase, the dermal filler in that area starts to break down and soften immediately. You will notice that there is a reduced appearance to the areas of filler at 48 hours post injection. Some patients feel discouraged initially as the effects are confused by some of the swelling that occurs with hyaluronidase injection, again this should all start to settle and show effect by 48 hours and bruising can last up to 2 weeks.
There are many reasons for dissolving these can include:
Here's where at times we lose some control as injectors. A patient's anatomy and how it functions will play a large role on where and how filler will settle. As injectors we are educated and have experience knowing which areas that filler shouldn’t be injected that may cause a problem in migration, however each individual's anatomy is so diverse. Ultimately filler will move to the path of least resistance to find a comfortable place to sit. Some patients tissues have more “pockets” or laxity and therefore less support in keeping a filler in place. Additionally filler is quite soft and moveable for the first 48 hours post treatment, so there can be some compression of filler around areas of higher muscular contraction or if a patient swells greatly post treatment, this can also cause some compression or movement of product.
This had a similar cause to the concepts explained above. Areas where we see lumps and bumps the most unfortunately is in the trough and lips. The tear trough because the skin is so thin and unforgiving here and anatomically it is quite unique and more complex. The lips because of the high muscular function the area, and tissue differences seems from patient to patient. Other areas of the face such as the chin, cheek bone, or nose, we are almost trying to create small “lump or bumps” referred to as boluses, to help lift the tissue and create structure. Here we try to ensure they are smooth and consistent , however we don’t want to over massage these areas, as we would lose the lifting or volumizing effect that was initially intended with the dermal filler injection.
This is where hyaluronic acid fillers are considered safer than other fillers on the market as we have the antidote to reverse them. An emergency case is where filler in unintentionally injected into a blood vessel. Filler in a blood vessel will cause a blockage and can cease blood flow and diffusion of necessary oxygen to the tissues. When the tissues don’t have oxygen they start to die and this is known as tissue necrosis. As experienced injectors we are aware of the signs and symptoms of a blockage and we will reverse this on the spot if seen. However at times the vessel doesn’t fully block, or these signs aren’t seen right away. In cases such as these we educate our patients on what to look for in the consultation. If a patient is presenting with signs of a blockage we will insist on immediate return to clinic to assess in person and if a blockage is confirmed we will start the dissolving process, which again can take multiple sessions until we are contact blood flow and circulation to vessels and tissues has returned.
Just like there are risks or adverse events associated with injecting dermal filler, hyaluronidase itself is not risk free as it can cause temporary discomfort of injection, redness, swelling, bruising and very rarely allergy.
Often if it is a patients first exposure to hyaluronidase, we will do a patch test on the arm to ensure the patient is not allergic to the product before proceeding with dissolving filler in facial tissues. A history of allergic reaction to wasp or bee stings represents an increased risk of allergic reaction to hyaluronidase and should be considered as a relative contraindication, as the venom of stinging insects might contain hyaluronidase and this mechanism might be the source of sensitization in affected individuals. Unless there is a past medical history of allergic reaction or anaphylaxis to hyaluronidase or insect bites, previous history of allergy seems unrelated for the administration of hyaluronidase and it can be safely performed.
It is normal to get some natural hyaluronic acid temporarily breaking down but this quickly regenerates with out own bodies natural HA product within a few weeks, and ultimately collagen remodelling that happens 2-3 months post.
If a patient is looking for some aesthetic adjustments, and wants to go ahead with dissolving, they must understand that they might also need to replace areas that may have dissolved unevenly with dermal filler. If the treatment was performed at another clinic, then this will be at the patients expense.
In addition to re-treatment, hyaluronidase can be repeated as soon as 2 weeks to add more dermal filler in a previously dissolved area to ensure all swelling and injury has resolved and the patient is back at baseline.