JMIR Publications

ABSTRACT

Background:

Hyaluronidase (Hyal) can reverse complications of hyaluronic acid (HA) fillers which has contributed substantially to the popularity of such procedures. Still, there are differing opinions regarding Hyal treatment, including dosage recommendations, in filler complication management.

Objective:

To address unanswered questions regarding Hyal treatment for HA filler complications, including skin pretesting, properties of various Hyals and interactions with HA gels, timing and dosage, and pitfalls of treatment.

Methods:

Pubmed and Google Scholar databases were searched from inception for articles on Hyal therapy for filler complications. Articles were critically evaluated regarding their contribution to the field. The extensive literature review includes international leaders' suggestions and expert panels' recommendations.

Results:

There are limited controlled data but increasing clinical experience with Hyal treatment. Currently used Hyals provide good results and have an acceptable safety profile. Nonemergent complications such as the Tyndall effect, noninflamed nodules, and allergic/hypersensitivity reactions should be treated with low or moderate Hyal doses. Hyal should be considered with prior or simultaneous oral antibiotic treatment in managing inflammatory nodules. Hyal may be tried for granulomas that have not responded to intralesional steroids. Emergent complications such as vascular occlusion and blindness require immediate, high-dose Hyal treatment. Regarding blindness, the approach to injection, retrobulbar vs. supraorbital, remains controversial. Ultrasound guidance can increase the efficacy of the above interventions.

Conclusions:

Hyal is essential in aesthetic practice because it can safely treat most HA filler complications. Immediate Hyal treatment is required for emergent complications. Practitioners should be familiar with using Hyal and effective dosage protocols. Clinical Trial: Non-applicable