Hyaluronic acid (HA) dermal fillers are popular because they are reversible using an enzyme called Hyaluronidase. This enzyme specifically targets and breaks down the filler material. Hyaluronidase is a prescription-only medication that must be administered exclusively by a licensed medical professional. This process provides a safety net for patients who experience complications or are dissatisfied with their initial filler results. Understanding this enzyme and the procedure is important for anyone considering dissolving their HA filler.
Understanding Hyaluronidase and Indications for Use
Hyaluronidase is a naturally occurring enzyme found in the human body, though the product used in treatments is typically synthesized or derived from animal sources. The enzyme breaks down the complex structure of hyaluronic acid molecules. It achieves this by hydrolyzing the linkages that hold the long chains of the HA molecule together, turning the firm gel-like filler into a watery substance that the body can metabolize and excrete.
The indications for using hyaluronidase fall into two main categories: aesthetic correction and medical necessity. Aesthetic correction addresses non-urgent issues like overfilling, filler migration, asymmetry, or the presence of palpable lumps or nodules. These elective procedures are performed when the cosmetic outcome is unacceptable to the patient.
The second, more urgent category is medical necessity, primarily involving vascular occlusion. This complication occurs when filler is inadvertently injected into a blood vessel or compresses it, restricting blood flow and potentially leading to tissue death (necrosis). In such emergencies, the immediate and aggressive application of hyaluronidase is required to dissolve the blockage and restore circulation, which can prevent severe, permanent damage. For this reason, practitioners who inject HA fillers must have hyaluronidase immediately available.
The Procedure: What to Expect During Treatment
The process begins with a consultation and assessment by the medical professional, who determines the location, volume, and type of filler to be dissolved. This assessment is necessary for calculating the precise dosage of hyaluronidase. The enzyme is reconstituted from a powder form using bacteriostatic normal saline, and the concentration is tailored to the specific treatment goal.
Before the full treatment, a patch test is often performed to check for a severe allergic reaction, except in emergency cases like vascular occlusion. A small amount of hyaluronidase is injected intradermally, usually on the forearm, and the site is monitored for 20 to 30 minutes. Redness and slight swelling are expected. However, a significant reaction, such as itching or a large wheal, will prevent the elective procedure from moving forward.
Once safety is established, the treatment area is cleansed, and the hyaluronidase is injected directly into the targeted area using a fine needle. The sensation during injection is often described as a mild burning or stinging, though topical numbing cream may be applied beforehand.
The enzyme’s action is fast, with the breakdown of the filler often beginning almost immediately, and some visible effect may be noticed within minutes. However, the final result is best assessed after a few days, or sometimes up to two weeks, as initial swelling from the injection subsides.
Potential Risks and Post-Treatment Care
Following the procedure, patients commonly experience localized, temporary side effects, including redness, tenderness, swelling, and bruising at the injection sites. Swelling is particularly common and may be managed with a cold compress and sleeping with the head elevated for the first night. These reactions are generally mild and typically resolve within 48 hours.
A more serious, though rare, risk is a severe allergic reaction, including anaphylaxis, which requires immediate medical intervention. A positive patch test significantly reduces this risk for elective procedures. Another concern is the temporary effect of the enzyme on the body’s native hyaluronic acid. The enzyme may break down some natural HA, but the body’s own processes quickly restore the loss within 15 to 20 hours, meaning there are no long-term detrimental effects.
Post-treatment care involves avoiding strenuous exercise for 24 hours and refraining from applying makeup to the area for at least 12 hours to prevent infection. Patients are advised to avoid blood-thinning medications like ibuprofen for a short period, as these can increase bruising. A follow-up appointment is often scheduled, as highly cross-linked fillers may require a second session to achieve the desired level of dissolution.