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HYALURONIDASE: QUESTIONS & ANSWERS

Hyaluronidase

If you’ve had hyaluronic acid filler injections and have loved the outcome, you’ve no doubt wished the results could be permanent. That way you could skip the part where you have to watch the effects slowly disappear. It may, therefore, surprise you to know that one thing doctors (and many patients, too) love about hyaluronic acid fillers is that the effects can be undone, and quickly. An enzyme called Hyaluronidase can dissolve hyaluronic acid.

Most people who see an aesthetic beauty professional and receive hyaluronic acid filler are very satisfied with the way they look afterwards. But, from a statistical perspective, any procedure performed as often as dermal filler injections are has to result in some occasions where patients are not happy. Unwanted reactions occur in only a small percentage of cases. Yet you should be aware that dissolving facial filler is sometimes necessary from a medical point of view. For instance, every once in a long while, someone turns out to be allergic to hyaluronic acid. There are also times when the results are not as expected. There are visible lumps or perhaps over-correction, which is when too much filler has been injected. That’s where being able to get rid of facial filler turns into a big benefit.

It’s important to note that hyaluronidase only works on hyaluronic acid. Filler manufacturers also make fillers from other substances, such as polymethylmethacrylate, also known as PMMA (Bellafill), and polyacrylamide (Aquamid). As with hyaluronic acid, these fillers will eventually break down, and their effects will disappear. However, hyaluronidase won’t work on these substances. They’ll disappear only after the passage of months or years.

It goes without saying that you’ll choose a qualified and experienced dermatologist or plastic surgeon. Even with the most skilled injector, though, differences in anatomy and how filler settles can lead to results you don’t like. If that’s the case, these are some of the questions you might have:

HOW QUICKLY DOES HYALURONIDASE DISSOLVE HYALURONIC ACID?

This is the most frequently asked question about hyaluronidase. The short answer is that you should see results within minutes, and it shouldn’t take more than 24 hours. The long answer is that, due to different factors, there isn’t always a clear-cut timeline. Most but not all cases are resolved in a single session. Sometimes, the filler won’t dissolve until after a second session or even a third. Often, this is due to the cross-linking of the hyaluronic acid filler used.

Found in the human body, hyaluronic acid is a naturally occurring carbohydrate made up of sugar molecules. When manufacturers create the hyaluronic acid they use in their fillers, they link the long sugar chains together. This makes the hyaluronic acid more resistant to breaking down. It also makes it thicker, with a gel-like consistency. Hyaluronic acid fillers come in many different formulations, depending on the brand and the product line. There’s a lot of variety in how soft, dense, or stiff they are. The more cross-linking, the longer the filler lasts once injected into the human body.

That high degree of cross-linking also creates resistance to hyaluronidase’s effects. In these cases, patients may need several doses over a period of weeks to see the desired results.

HOW DO DOCTORS APPLY HYALURONIDASE TO REVERSE FACIAL FILLER?

Doctors administer hyaluronidase in pretty much the same way they inject dermal fillers. The practitioner may or may not apply a local anesthetic or numbing gel, depending on the patient’s sensitivity. She’ll then proceed to inject the hyaluronidase.

She’ll do the injections according to whatever correction treatment plan she and the patient have decided on. For example, the goal could be to fix an outcome that isn’t symmetrical. With a small amount of enzyme, she would dissolve just enough filler so that both sides of the face look even. Or the aim might be to undo the entire treatment. In that case, she would use a greater amount of hyaluronidase to break down all the hyaluronic acid present.

HOW MUCH TIME NEEDS TO PASS BEFORE YOU CAN RECEIVE HYALURONIDASE?

You don’t need to wait a specified amount of time before getting hyaluronidase. A doctor can apply it right after you’ve had facial fillers. That said, many doctors recommend waiting up to two weeks before having any hyaluronidase treatments. This gives the filler time to settle. That makes it easier to see exactly what needs to be undone.

You can even have hyaluronic acid filler dissolved months or potentially years after getting it injected. As long as the hyaluronic acid filler is there, hyaluronidase will work to break it down.

CAN PRACTITIONERS USE HYALURONIDASE TO FINE-TUNE THE RESULTS OF FILLER INJECTIONS?

Doctors do use hyaluronidase to correct cases of asymmetries and of overfilling, and, of course, their skill and experience do count. Still, you should keep in mind that hyaluronidase injections don’t work with pin-point accuracy. The most difficult part of using the enzyme is calculating the exact amount needed to dissolve a given amount of filler. The hyaluronic acid can dissolve unevenly because of things like the density of the tissue or how resistant the filler is to being broken down. The hyaluronidase injections can end up eliminating a greater amount of filler than the patient wanted. Just like placing filler, removing it can be as much art form as science, and art doesn’t always work with exact precision. The line between fixing an over-correction and trying to tweak acceptable results to perfection can be very fine indeed.

IS HYALURONIDASE SAFE?

Practitioners consider the use of hyaluronidase to be safe. There are two main risks when receiving it:

The possibility that it will dissolve your own hyaluronic acid

Since the presence of hyaluronic acid in our skin is one of the things that makes us look younger, you might worry that hyaluronidase will dissolve your own hyaluronic acid. Fortunately, this almost never happens, and if it does, it’s not a big problem. While hyaluronidase injections have been known to dissolve small amounts of the patient’s own hyaluronic acid, the human body is constantly regenerating this substance. The skin in the injection zone might look a bit dehydrated, wrinkled, or deflated if your own hyaluronic acid disintegrates. But it’s a temporary condition. It will resolve itself in a day or two as your body makes more of its own.

The possibility of an allergic reaction

The hyaluronidase that doctors use either comes from animal sources, such as cows or sheep, or from laboratory-produced recombinant human sources. Reports exist of allergic reactions, but they’re rare. Hyaluronidase derived from animals poses a greater risk. Also, hyaluronidase is present in wasp and bee venom. People with allergies to bee and wasp stings are at higher risk of being allergic to the enzyme. For first-time patients, some doctors perform a patch test with a very small amount of hyaluronidase solution. If you have any known allergies to sheep or cow proteins or to bee stings, you should definitely mention this to your aesthetician before having dermal fillers injected. She can then decide whether hyaluronidase is safe for you or not.

HOW SOON AFTER HAVING HYALURONIDASE TREATMENT CAN I HAVE HYALURONIC ACID FILLER RE-INJECTED?

If you’ve had hyaluronidase treatment, there’s no reason you can’t have hyaluronic acid filler injections once again, even in the very same area where the doctor dissolved the filler before. You just can’t have them at the same visit where she administered the hyaluronidase.

The question of how much time has to pass before re-injection doesn’t, unfortunately, have a simple answer. It really depends on the individual doctor. Most aesthetic medicine professionals agree that two things have to happen. First, the hyaluronidase has to stop acting to dissolve hyaluronic acid. Second, any inflammation or swelling in the region has to have disappeared. Hyaluronidase can continue to act for several days, so most doctors say to wait at least 48 hours. Swelling, on the other hand, can take weeks to resolve.

So, a practitioner might suggest waiting periods of one to three days, a month, or anything in between. It depends on the patient’s individual circumstances. It also depends on the doctor’s comfort level, since he’ll be judging how much filler to re-inject and where to place it. Follow his recommendations and you’ll likely be really pleased with your new filler.

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