Hyaluronic acid Dermal filler can be dissolved by the injection of Hyaluronidaese enzyme which take 1-2 weeks to work. There are many reasons that the filler has to be dissolve or has been requested to be dissolved for example:
- Over filled
- The filler has moved or spread to other areas
- Lumps and unevenness of dermal filler result
- Asymmetrical result
- Allergic reaction: swelling
- Late reaction: swelling lump at the filler areas which commonly see at tear through areas even a few months after the filler has been injected.
- Infection
Infection nearby the areas of dermal filler can cause immune reaction that cause swelling and tender hard lump at the areas that has dermal filler.
🔴YOU CAN ONLY DISSOLVE FILLER THAT CONTAINS HYALURONIC ACID🔴
The process of Dermal filler dissolving.
- Consultation: you will examine the areas and discuss with you to determine the areas that need to be dissolve and explain the procedure, risk and after dissolving plan.
- Patch test: As there is a small chance of allergic reaction of Hyaluronidase enzyme, a patch test by injecting a small amount of the enzyme at one of your arms is needed to eliminate risk of the allergic reaction. You will need to wait 30 minutes at the clinic to see the result of the patch test. Sign of allergic reaction are swelling, rash and redness at the injection site. If there is non sign of allergy, the Hyaluronidase will be injected to the decided areas.
- Numbing cream can be applied on the areas that need dissolving 15-20 minutes before the injection.
- Hyalurodidase enzyme injection at the affected / problematic areas
Different HA fillers have differing physical properties that influence their degradation by hyaluronidase in a time and dose- dependent manner.
Hyaluronidase may be reconstituted with either saline or water for injection. Saline is less painful on injection and is recommended for this reason. Although unlicensed for this purpose, bacteriostatic saline is often preferred for its additional anaesthetic properties. The volume of diluent used will depend on the indication and surface area to be treated. A range of 1-10mls has been evidenced in clinical practice and published papers.
- the area should be inspected, palpated and marked out if needed. It should then be cleansed and disinfected using an appropriate skin solution and the procedure should be carried out using an aseptic technique.
- A 27G or 30G needle with an appropriate length to treat the depth of the area should be used. Administration should be accurate and limited to the affected area.
- For vascular compromise, serial puncture should be used to inject hyaluronidase along the course of the vessel and covering the affected area.
- During and after the procedure, the treated area should be massaged rather vigorously to optimise the result and aid mechanical breakdown.
- Depth may be difficult to assess on palpation; therefore injections should cover the upper and lower borders of the product that has been injected.
- Hyaluronidase may be reconstituted with either saline or water for injection. Saline is less painful on injection and is recommended for this reason. Although unlicensed for this purpose, bacteriostatic saline is often preferred for its additional anaesthetic properties. The volume of diluent used will depend on the indication and surface area to be treated. A range of 1-10mls has been evidenced in clinical practice and published papers.
The most difficult part of using hyaluronidase is estimating the dosage amount required to dissolve the filler.
A consensus opinion in the literature states five units of hyaluronidase is needed to break down 0.1ml of 20mg/ml HA. Hyaluronidase has immediate effect and a half-life of two minutes with duration of action of 24 to 48 hours. Though it has a short half-life, its effectiveness lasts longer.
| Hyaluronidase units | |
| Nasal and perioral skin | 15-30 |
| Periorbital | 3-45 |
| Infraorbital | 10-15 |
| Lower Eyelid | 15 |
There are non-dissolvable fillers on the market like hydroxylapatite (Radiesse), poly-l-lactic acid (Sculptra), polymethyl methacrylate (Bellafill), and off-label liquid silicone (Silkon-1000) which are not reversible or dissolvable with hyaluronidase. However, these, along with bio-stimulating fillers, are not as commonly used as HA fillers.
Vascular occlusion –
Hyaluronidase should be administered as soon as this complication occurs (within 4 hours). There is strong evidence that tissue necrosis can be prevented or reduced in severity if treatment is administered within 48 hours.
Dosages for vascular occlusion. In the event of a suspected vascular obstruction, a high dose pulsed protocol should be adopted. Large volume of hyaluronidase (450–1500 units) should be infiltrated over the entire area including the course of the vessel.
STORAGE AND RECONSTITUTION
It is recommended that hyaluronidase be stored at cool temperatures (2–8˚C, 35–46˚F) to maintain the quality of the product over a long period of time. If stored at room temperature (25˚C, 77˚F), the stability is only guaranteed for 12 months. Once the ampoule is opened, hyaluronidase should be used immediately and any unused contents discarded (Hyalase® SPC).
After care
It is recommended not to touch or apply any make up on treated areas for 6 hours to prevent infection. Any swelling can be reduced by taking antihistamine. Bruising can be reduced with Arnica cream or tablets.
