Hyaluronidase

Hyaluronidase is an enzyme used to break down hyaluronic acid. In aesthetic medicine, it may be used to partially or fully dissolve hyaluronic acid dermal filler.

It is sometimes considered when filler has migrated, caused lumps or asymmetry, been overcorrected or produced an unwanted result. It may also be used as part of the urgent management of certain filler complications.

Hyaluronidase does not dissolve permanent fillers or most collagen-stimulating fillers. An appropriately qualified medical practitioner should first assess the product used, the treatment area and the reason for correction.

Read more about filler treatment.

What is hyaluronidase?

Hyaluronidase is an enzyme that breaks down hyaluronic acid. It is sometimes known by the brand name Hyalase.

When injected into an area containing hyaluronic acid filler, it can help reduce or remove the filler. The amount required varies according to the product, the volume injected, the treatment area and whether a partial or full correction is intended.

One session may be sufficient for a small correction. Older, larger or more resistant deposits may require further treatment.

Read more about what fillers are.

Hyaluronidase treatment at a glance

Treatment time: Usually 15–30 minutes

Anaesthetic: Often unnecessary, although numbing cream may be offered

Recovery: Swelling and tenderness may last several days

Initial change: Often noticeable within 24–48 hours

Assessment: Usually after approximately one week

Suitable for: Hyaluronic acid dermal fillers

Number of sessions: Depends on the filler and the correction required

When is hyaluronidase used?

A practitioner may consider hyaluronidase when a previous hyaluronic acid filler treatment needs to be corrected.

Reasons may include:

• filler migration;

• lumps or unevenness;

• asymmetry;

• overcorrection;

• the Tyndall effect;

• an unwanted cosmetic result.

Hyaluronidase may also be used as part of the urgent treatment of a suspected vascular occlusion. Severe or increasing pain, pale or mottled skin, unusual discolouration or visual symptoms after filler treatment require immediate medical assessment.

Read more about how long do filler last.

Does hyaluronidase treatment hurt?

Most people experience brief pinching, stinging or a mild burning sensation during the injections. Numbing cream may be offered for sensitive areas.

Temporary redness, swelling, bruising or tenderness can occur afterwards. These effects usually settle as the area recovers, although recovery time varies between individuals.

Which fillers can hyaluronidase dissolve?

Hyaluronidase works on fillers made from hyaluronic acid. Common brands include:

• Juvéderm;

• Restylane;

• Teosyal;

• Stylage;

• Belotero.

The response can vary according to the brand, formulation, amount, location and age of the filler. A consultation is needed to determine whether partial or complete dissolution is realistic.

Read more about dissolving fillers.

Which fillers cannot be dissolved?

Hyaluronidase does not dissolve fillers made from materials other than hyaluronic acid.

This includes permanent fillers and most collagen-stimulating fillers, such as products based on poly-L-lactic acid or calcium hydroxylapatite.

When the original product is unknown, the practitioner may review treatment records or recommend an ultrasound assessment before proceeding.

How quickly does hyaluronidase work?

The enzyme starts acting after injection, but swelling may temporarily hide the change.

A first difference may be noticeable within 24 hours. The area can often be assessed more clearly after 24–48 hours, with a fuller review after approximately one week.

More than one session may be needed when a large volume of filler is present or when the product is older or highly cross-linked.

Read more about how fillers work.

When is hyaluronidase unsuitable?

Hyaluronidase is not suitable for fillers that do not contain hyaluronic acid. It may also be inappropriate when the concern is caused by another issue, such as skin laxity, natural volume loss or swelling unrelated to the filler.

The cause of the concern should therefore be assessed before treatment is recommended.

Can you have filler again after hyaluronidase?

Further filler treatment may be possible once the area has recovered.

The appropriate waiting period depends on why the filler was dissolved, the condition of the tissue and the practitioner’s assessment. A longer recovery period may be recommended following a complication.

Possible risks and side effects of hyaluronidase

Hyaluronidase for filler complications

Hyaluronidase can be used for cosmetic corrections and as part of the medical management of certain complications.

Filler migration

When hyaluronic acid filler has moved beyond the intended treatment area, hyaluronidase may be used to reduce or remove it.

Read more about filler migration.

Lumps and unevenness

A small, localised amount may sometimes be used for a lump or irregular area. Not every lump is caused by excess filler, so an assessment is necessary.

Read more about filler lumps.

Tyndall effect

The Tyndall effect is a blue or grey appearance that can occur when hyaluronic acid filler is placed too close to the skin surface. Dissolving the superficial filler may improve it.

Vascular occlusion

Hyaluronidase may form part of the urgent treatment of a suspected vascular occlusion caused by hyaluronic acid filler. This requires immediate assessment by a suitably trained medical professional.

Seek urgent medical help after filler treatment if you develop severe or increasing pain, pale or blotchy skin, unusual discolouration or any change in vision.

Read more about filler necrosis.

How much does hyaluronidase cost?

The cost varies between clinics and depends on the extent and complexity of the correction.

Factors that may affect the price include:

• the size of the treatment area;

• the amount and type of filler present;

• the quantity of hyaluronidase required;

• whether ultrasound assessment is needed;

• the number of treatment sessions;

• follow-up appointments.

The clinic should explain the expected fees before treatment. Exact prices should be taken from the clinic or Nova rate database rather than added manually.

How to choose a clinic

Dissolving filler requires an accurate assessment and a detailed understanding of facial anatomy.

When comparing clinics, consider:

• experience with hyaluronidase and filler correction;

• experience managing filler complications;

• the qualifications of the treating practitioner;

• clear information about risks, fees and expected follow-up;

• access to urgent aftercare;

• independent patient reviews.

For complex cases, experience with ultrasound assessment or ultrasound-guided correction may be helpful.

Does hyaluronidase work on every filler?

Hyaluronidase can dissolve hyaluronic acid fillers, including products such as Juvéderm, Restylane, Teosyal, Stylage and Belotero.

It does not dissolve permanent fillers. Most collagen-stimulating fillers also cannot be dissolved with hyaluronidase.

When the filler type is uncertain, the practitioner should identify the likely product before treatment.

Compare clinics offering hyaluronidase treatment

Choose a clinic with relevant experience in filler correction and complication management.

Compare the qualifications of the practitioner, available assessment methods, treatment fees, aftercare arrangements and independent patient reviews. During a consultation, the practitioner can advise whether a partial or complete correction is appropriate.

Frequently asked questions about hyaluronidase