beverly Hills, CA
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hyaluronidase to the rescue
February 7, 2012 9:02 PM
Nonanimal, stabilized hyaluronic acid (NASHA) gels such as Restylane and Juvederm have become a very popular dermal fillers. . Hyaluronidase is an excellent agent to speed resorption by
Nonanimal, stabilized hyaluronic acid (NASHA) gels such as Restylane and Juvederm have become a very popular dermal fillers. . Hyaluronidase is an excellent agent to speed resorption by breaking up the gel. To evaluate hyaluronidase's effects on previously implanted NASHA gel, researchers performed a two-part study.
In the first part, 12 healthy volunteers had 0.2 mL of NASHA gel injected into two sites on one forearm. One to 3 days after implantation, a blinded evaluator graded the cutaneous augmentation at both sites, and 75 units of hyaluronidase with thimerosal preservative were injected into one site and control saline into the other. Within 4 to 7 days of hyaluronidase injection, 80% of the NASHA gel had clinically disappeared at the hyaluronidase site, while 90% of the gel persisted at the control site.
The second part of the study was designed to measure the dose-dependent effects of hyaluronidase. Eight new volunteers received three injections of NASHA gel, 3 cm apart, on one forearm. Three to 5 days later, a different concentration of preservative-free hyaluronidase (10, 20, or 30 units) was injected into each of the three implantation sites in each subject. Four to 7 days later, the 30-U sites had no palpable gel, and the 20-U and 10-U sites demonstrated dose-dependent reductions. About 25% of the subjects in both parts of the study developed local reactions at the hyaluronidase-injected sites; the reaction was more pronounced with injections containing thimerosal.
Hyaluronidase injections are very useful in reducing NASHA gel overcorrection. The desired level of flattening can be achieved by carefully titrating the dose, and larger doses completely eliminate NASHA gel effect from the implantation site. The injection can be done several days after implantation, when the procedure-associated edema has mostly resolved. Localized reactions to hyaluronidase were frequent at the doses used. Patients with a history of allergy to bee venom or to the preservative should not be injected.
The problem with this study is the size of the hyaluronidase dose and implantation volume were large. Usually for a small lump I can dissolve it within 24 hours with 20u of hyaluronidase