Does Hyaluronidase dissolve your face permanently?

Does Hyaluronidase affect human tissue as well as dissolving the HA filler?

We get asked this question ALL the time.  Patients will tell us after searching 'RealSelf.com' that hyaluronidase will 'eat their face'.  Such as the below comments

It is an important question that as injectors we must be able to answer.

Dr Casabona performed an interesting study in 2018 to help us answer this question more adequately for our own patients.

Casabona G, 2018

Dermatol Surg. 2018 ;44;S42-s50

Our Summary –

OBJECTIVE:

Dr Casabona aimed to assess the behaviour different Hyaluronidase products.  Some fillers are cross-linked differently, this could impact the time they take to dissolve. Dr Casabona wanted to see the difference in dissolving rates for some of the fillers vs the type of hyaluronidase.

She also wanted to see the impact of Hyaluronidase on human tissue.

METHODS AND MATERIALS:

The study subject was a healthy, consenting adult woman scheduled to undergo abdominoplasty. Skin to be excised was injected with 0.1 to 0.2 mL of each filler (10 injections each) leaving a visible lump. Immediately afterward, the HA lumps were injected with 4 IU of each Hase product every 2 minutes until the HA lumps were no longer visible or palpable. This procedure was repeated after 30 days. Injected tissues were excised after abdominoplasty for histological analysis.

Types of fillers used are below - a varied collection of cross-linking and G-Primes

Types of Hyaluronidase used in the researcch below - 5 types

Below - shows the grid used on the patient - 0.2ml or 0.1ml of each filler in each grid. 5 squares each.

Every 2 mins each site was injected with Hyaluronidase until the HA filler lump was no longer palpable or visible.  This was repeated 30 days in another area of the patients body for this purpose.

RESULTS:

The 5 Hase products displayed a wide range of doses and times required to completely degrade the 5 HA products (Table 3). Hase-1 was the fastest of 3 products (60%).

What about the impact on the human HA?

There were depressions in areas that recieved MORE than 50 u Hyaluronidase.  There was also a noticed difference in resistance to pinching.  These changes returned to normal in 48 hours.

CONCLUSION:

There is a wide range in sensitivity to hyaluronidase over these 5 different types.  Also the type of filler (cross-linking, overall HA concentration) can affect the time and dose of Hyaluronidase required to dissolve.

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