Nothing makes doctors and patients less happy than having an unsatisfactory result after an aesthetic treatment. In the past, if an error was made in the injection of a dermal filler, a patient’s only option was to wait for several months for the product to naturally break down and reabsorb. While not all outcomes can be reversed, many doctors are fortunately finding success in quickly breaking down some unwanted dermal filler results by using hyaluronidase.
Hyaluronidase is an enzyme that has the ability to degrade hyaluronic acid and is officially approved by the FDA to improve the dispersion and absorption of other drugs, such as anesthetic agents.
Dr. Harold J. Kaplan, a Los Angeles facial plastic surgeon, writes on the cosmetic procedure community web site RealSelf.com, “The use of hyaluronidase to dissolve hyaluronic acid dermal fillers is very effective and safe. Although its use in this manner is not FDA approved, this off-label use is very acceptable and beneficial. In fact, using HA dermal fillers anywhere besides the laugh lines (nasolabial folds) is also considered off-label, but considered a standard of practice.”
Hyaluronidase has been effective in negating the effects of the following hyaluronic acid fillers:
Hyaluronidase can only assist in the break down of fillers made of hyaluronic acid and will not offer any reversing effects on the following products:
In a study published in Journal Watch Dermatology in 2005, test subjects were injected with 0.2 mL of hyaluronic acid dermal filler in two areas on the forearm 10 cm apart. One to three days later, “75 units of hyaluronidase with thimerosal preservative were injected into one site and control saline into the other. Within 4 to 7 days of hyaluronidase injection, 80% of the NASHA gel [filler] had clinically disappeared at the hyaluronidase site, while 90% of the gel [filler] persisted at the control site.”
The study also reported about a 25 percent occurrence of localized allergic reaction at the injection site, which was more pronounced with hyaluronidase containing the thimerosal preservative. Ideally, allergy testing should be performed along an inner forearm area and observed for one or two days to minimize the risk of allergic reaction on the face.
Hyaluronidase To Correct Dermal Filler Mistakes
For those patients who want just a little reduction or a little less filler, hyaluronidase is not an effective option due to its “all or nothing” nature. It does not seem to have much effect on the body’s natural hyaluronic acid, however.
The average cost of a hyaluronidase treatment is $600, making it an expensive option on top of initial dermal filler treatment costs. If a patient can live with her results or is only mildly dissatisfied, most doctors advise old-fashioned patience as the best option.
Brand names of animal-derived hyaluronidase include HydaseTM, which has been FDA approved as a “thimerosal-free” animal-derived hyaluronidase, Vitrase, Amphadase, and Wydase. Wydase, however, is no longer manufactured.
On December 2, 2005, the FDA approved a synthetic “human-derived” hyaluronidase called Hylenex.
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