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A progressive loss of dermal hyaluronic acid is one of the hallmarks of ageing skin.
The reasons for the decline is a consequence of reduced synthesis levels of hyaluronic acid in the skin and progressive degradation of hyaluronic acid due to other, stress factors such as repeated and extended exposure to UV radiation
Injection of dermal filler (hyaluronic acid) has become increasingly popular and is now the preferred treatment for performing soft tissue augmentations, deep skin hydration (“skin boosters”), or facial contouring.
One major advantage of HA-based fillers, compar to other
for example calcium hydroxyl apatite-based (CaHA) or poly-l-lactic acid-based fillers (PLA), is the availability of a specific antidote, hyaluronidase, which is considered a rescue medication for the management of complications resulting from filler injections.
Potential complications of aesthetic filler injections include
- the tyndall effect (bluish like discoloration of the skin)
- lower eyelid oedema following tear-trough augmentation.
Furthermore, granulomatous reactions, infections, visual impairment, or even blindness, as well as, local tissue necrosis caused by vascular occlusion as a result of intravascular HA injections or sidewall compression of vascular structures, can occur.
Hyaluronidase is injected by use of a thin needle to the place where the filler was previously injected, e.g. lips, cheeks or around the eye. The first effects may be visible after a few minutes, but in the case of edema, they can be imperceptible. Hyaluronidase works for up to 72 hours. After this time, the effect should be assessed and the doctor may decide on the need to repeat the hyaluronidase procedure. This procedure can be carried out up to several months after the filler has been applied.
Hyaluronidase is mainly used to remove too much hyaluronic acid or to dissolve the wrongly selected filler. The treatment eliminates lumps and bumps caused by too shallow acid application or movement of the filler. The enzyme can also remove the effects of accidental hyaluronic acid injection into a vein or artery1.
Hyaluronidase dissolves hyaluronic acid administered not only in the form of a filler, but also its own, i.e. natural acid present in human skin. This process takes up to about 3 weeks; after this time the defect gradually recovers. Improvement of skin condition usually occurs within 24 hours to 7 days after administration of the enzyme. Hyaluronidase is metabolized and excreted from the body within a week of application.
The first effects of hyaluronidase administration may be noticeable after a few minutes. Over time, they become more and more visible. The enzyme can be used immediately after administration of hyaluronic acid or at other times, even after a few months after the procedure with the filler. However, in this case, the administration of hyaluronidase may be less effective2. As a result of using the enzyme, the excessive amount of hyaluronic acid is reduced, thanks to which the surface of the skin is smoother, and lumps and swelling disappear.
Hyaluronidase is a physiological enzyme in the body whose function is the degradation of hyaluronic acid. Hyaluronidase is used in aesthetic medicine - it allows correction or reversal of the effects of the procedure using hyaluronic acid as a filler.
What is hiaruronidase?
Hyaluronidase used in aesthetic medicine is obtained most often from the venom of hymenoptera insects or snakes. Preparations containing hyaluronidase are used to depolymerize hyaluronic acid, which is used as a filler in aesthetic medicine procedures. Hyaluronic acid is used primarily to enlarge lips, shape their shape, compensate for asymmetries. In addition, cross-linked hyaluronic acid is used in volumetric procedures, i.e. modeling the cheeks or chin, as well as filling deep wrinkles and furrows. Treatments using hyaluronic acid as a filler are considered very safe. First of all, because hyaluronic acid is perfectly tolerated by the body and rarely leads to the appearance of an allergic reaction. Sometimes, however, the effect of the hyaluronic acid treatment is much different than expected. What could go wrong?
Indications for use of hyaluronidase
Complications after using hyaluronic acid are rare. They may relate to the wrong technique of the procedure. Then too much hyaluronic acid may be used, which gives the effect of excessively enlarged lips. Too shallow introduction of filler can lead to unsightly lumps under the skin. Another complication is the displacement of hyaluronic acid outside the surgical site, and a very rare complication is hyaluronic acid allergy. A very dangerous undesirable effect of improperly performed surgery may be the injection of hyaluronic acid into the lumen of the blood vessel and its light clogging. And this can lead to skin necrosis. In the event of any of the listed complications of hyaluronic acid surgery, hyaluronidase must be used.
Hyaluronidase treatment - what does it look like?
Hyaluronidase treatment involves injecting a specific area of the skin with a preparation containing an enzyme, using a thin needle. The administration of hyaluronidase causes the degradation of previously injected hyaluronic acid, and to a small extent - also hyaluronic acid present physiologically in the body. One time use a small volume of hyaluronidase, and if necessary - repeat the procedure. The procedure itself lasts several minutes and must be preceded by an allergic test. The first effects are noticeable immediately after the end of the procedure, but the evaluation of the final effect can take place only after 72 hours, because this is the duration of hyaluronidase. In addition, a small swelling may occur immediately after the procedure, which will make it impossible to evaluate the effects.
Complications after using hyaluronase
Complications after using hyaluronidase are extremely rare. You may get a skin rash, dizziness, blurred vision, nausea and vomiting, increased heart rate or increased body temperature. The risk of complications increases in people allergic to hymenoptera venom. Hyaluronidase used in aesthetic medicine may favor the occurrence of cross reactions, which in extreme cases may lead to anaphylactic shock. In addition, the effect of hyaluronidase on the degradation of natural physiological acid can promote the loosening of intercellular connections and creates conditions conducive to the development of infection. However, the risk of side effects is low, and hyaluronidase injections are still the only treatment for complications after using hyaluronic acid. It should be remembered that hyaluronidase injection procedure can only be performed by a doctor experienced in performing aesthetic medicine procedures.
Hyaluronidase is an enzyme belonging to the group of hydrolases that depolymerizes, i.e. breaks down, hyaluronic acid in the skin. It is produced by bacteria and some cells of the human body; is one of the components of hymenoptera venom (bees, wasps, hornets) as well as bovine and sheep proteins. This enzyme is one of the two main bee venom allergens. Hyaluronidase is widely used in medicine, mainly in orthopedics, surgery, ophthalmology, oncology, dermatology and gynecology, but also in aesthetic medicine, where it is mainly used to remove the negative effects of using hyaluronic acid, the most popular filler on the market. Used to dissolve fillings and treat complications resulting from the administration of this preparation. Before administering the enzyme, it is necessary to conduct a thorough medical history with the patient, as this has a significant impact on the effectiveness of the procedure and its proper course.
Hyaluronidase is injected precisely with a very thin needle. A small amount of the preparation is given directly to the deposit (papules) formed after the administration of hyaluronic acid. Bruising or swelling may appear after the injection, which is small and disappears relatively quickly. Sometimes the use of an enzyme causes side effects; the most common are: soreness at the injection site, local inflammatory skin reaction, urticaria, pruritus or microvascular inflammation. However, more serious side effects may occur, such as hypotension, erythema, convulsions, dizziness, chills, nausea or vomiting, as well as severe allergic reactions, including anaphylactic shock and death. For this reason, the treatment with hyaluronidase can only be performed by properly trained doctors after having performed an allergic test. In the event of a blockage of the blood vessel resulting from the administration of hyaluronic acid, hyaluronidase should be immediately used with full shock protection.
The number of treatments ensuring optimal effects of therapy
In some people, the first results of using hyaluronidase may appear after a few minutes, but this is not always the case. This enzyme works for up to 72 hours, which is why an aesthetic medicine doctor should evaluate the results after this time and possibly decide to re-use hyaluronidase. The procedure can be carried out even after a few months after the filler has been applied, however in this case the effectiveness of the procedure should be taken into account. Hyaluronidase is an enzyme that dissolves both hyaluronic acid administered in the form of a filler, as well as its own, i.e. natural hyaluronic acid present in the skin. It is a process lasting up to about 3 weeks, followed by gradual reconstruction of the defect. Skin condition improvement usually occurs within 24 hours to 7 days after administration of the enzyme. Hyaluronidase should be metabolized and excreted from the body maximum within a week of surgery.
Indications for use of hyaluronidase
The procedure is performed to:
removing the effects of accidental injection of hyaluronic acid into a vein or artery;
removing too much filler with hyaluronic acid;
elimination of lumps and unevenness due to too shallow application of hyaluronic acid;
removing the moving filler;
dissolving improperly selected filler with hyaluronic acid.
Contraindications to the use of hyaluronidase
The procedure cannot be performed in the case of:
allergy to hymenoptera venom (bees, wasps, hornets) or bovine and sheep proteins;
bacterial, viral and fungal skin infections at the injection sites;
ulcers or damaged skin in the treated areas.