What dose of Hylenex (hyaluronidase) is used to dissolve hyaluronic acid filler?

Hyaluronidase Dosing for Dissolving Hyaluronic Acid Filler

For dissolving hyaluronic acid filler, inject 1-6 ml of hyaluronidase (150 units/ml) directly into the area of concern, with the general guideline being 1 ml of hyaluronidase solution for each 1 ml of extravasated filler. The dose should be adjusted based on the type of filler, with more highly cross-linked fillers like Voluma requiring higher doses.

Dosing Guidelines by Filler Type

Different hyaluronic acid fillers respond differently to hyaluronidase based on their cross-linking properties:

• Standard HA fillers (Restylane, Juvederm Ultra):

  • Starting dose: 5-10 units per 0.2 ml of filler
  • Responds well even to lower doses (2.5 units)

• Highly cross-linked HA fillers (Juvederm Voluma):

  • Requires higher doses: 10-20+ units per 0.2 ml of filler
  • May need repeated treatments
  • Doses below 2.5 units may be ineffective 1

Administration Technique

1. Direct injection: Administer hyaluronidase directly into the area of filler placement
2. Multiple puncture technique: For larger areas, use multiple small injections
3. Timing: Effects begin within 30 minutes and continue through 3 hours, with gradual degradation through 2 weeks 1

Special Considerations

For Vascular Complications

For suspected vascular occlusion (emergency situation):

• Use high-dose pulsed hyaluronidase protocol
• Administer repeated high doses hourly until resolution (detected through capillary refill, skin color, and absence of pain)
• Continue until clinical signs of ischemia resolve 2

For Overcorrection or Misplacement

• Standard dosing is typically effective
• Results can be seen within hours 3
• May require repeat treatments for complete resolution

Precautions

1. Allergy testing: Consider skin testing before administration due to risk of hypersensitivity reactions

2. Contraindications:

   • History of bee sting allergy (potential cross-reactivity) 4
   • Active infection at injection site

3. Monitoring: Observe for:

   • Local reactions: redness, swelling
   • Systemic reactions: rare but possible 5

Follow-up

• Assess results after 24-48 hours
• If incomplete dissolution, additional treatment may be administered
• Complete resolution typically occurs within 24-48 hours for standard fillers 6

Practical Tips

• For standard cosmetic corrections, start with lower doses and titrate up as needed
• For emergency situations (vascular occlusion), use higher doses immediately
• When treating areas near blood vessels, injecting hyaluronidase in the vicinity of the vessel is sufficient rather than directly into the filler 5
• The reaction of hyaluronidase is affected by the hyaluronic acid concentration, number of crosslinks, and form of the filler 5

Remember that hyaluronidase is rapidly degraded in the body, so sufficient amounts must be injected close to the filler for effective dissolution. This is particularly important for emergency situations involving vascular complications.