From the Research
Hyaluronidase can be used more than 72 hours after an incident, though its effectiveness may be reduced compared to earlier administration. The optimal window for hyaluronidase administration is within the first 24-48 hours after a filler complication or vascular occlusion, when it can most effectively break down hyaluronic acid fillers 1. However, there are documented cases where hyaluronidase has successfully dissolved hyaluronic acid fillers weeks or even months after injection. When using hyaluronidase after the 72-hour mark, higher doses may be required, typically starting with 150-300 units for each area requiring treatment, with potential need for repeated treatments.
Key Considerations
- The enzyme works by breaking down hyaluronic acid molecules by cleaving the glycosidic bonds, allowing for resorption of the material 2.
- While delayed administration is possible, patients should understand that complete resolution of the filler may be more difficult to achieve and multiple sessions might be necessary.
- Any signs of vascular compromise should still be treated as an emergency regardless of when the original filler was placed, as hyaluronidase remains the primary treatment option even in delayed presentations 1.
- A recent study published in 2024 supports the use of hyaluronidase in aesthetic practice, highlighting its effectiveness in managing complications associated with hyaluronic acid filler injections 3.
- Another study published in 2024 provides evidence on the use of hyaluronidase for the reversal of uncomplicated hyaluronic acid filler injection nodules, although further studies are needed to establish the ideal treatment protocol for facial skin or management of complications associated with aesthetic hyaluronic acid injection 4.
Administration and Dosage
- The dose of hyaluronidase required may vary depending on the individual case and the severity of the complication.
- Higher doses may be required for more severe complications or for cases where the filler has been in place for an extended period.
- The use of hyaluronidase should be guided by clinical judgment and experience, taking into account the individual patient's needs and circumstances.
Safety and Efficacy
- Hyaluronidase is generally considered safe and effective for the treatment of hyaluronic acid filler complications, although allergic reactions and other adverse effects can occur 2, 3.
- Patients should be informed of the potential risks and benefits of hyaluronidase treatment and should be closely monitored for any adverse effects.
- The majority of respondents in a survey of healthcare practitioners reported never observing an acute reaction to hyaluronidase, and only a small percentage reported observing anaphylaxis or other serious adverse effects 3.