Hyaluronidase
how filler is broken down

What hyaluronidase is, when it is used to break down hyaluronic acid filler, how quickly it works and when it does not help.

One of the biggest advantages of hyaluronic acid filler is that it can be corrected. The enzyme that makes this possible is called hyaluronidase. It breaks down hyaluronic acid, and the body absorbs and removes it.

When it is used

• For a vascular complication — when the filler blocks or presses on a blood vessel. This is an emergency, in which high doses are given quickly.
• For an unsatisfactory aesthetic result — too much volume, asymmetry, visible lumps or a bluish tint showing through the skin.
• When lumps and swelling appear after filler.
• When the patient simply wants to return to how they looked before.

How it goes

• The enzyme is injected with a fine needle or cannula into the area of the filler, in small doses.
• A skin allergy test of the hyaluronidase is performed to prevent a severe allergic reaction to the product.
• Action begins within hours, but the full effect is seen over a few days, and sometimes up to 1–2 weeks.
• A second or third session is often needed, especially with denser products.
• Temporary swelling, redness and tenderness may occur.

What is not broken down

• Hyaluronidase acts only on hyaluronic acid.
• It does not remove other types of filler — for example calcium hydroxylapatite or polylactic acid (collagen stimulators).
• It does not remove your own fat from fat grafting and does not affect botulinum toxin.

Is “everything” broken down

The enzyme can also break down some of the tissue’s own hyaluronic acid, but the body restores it within a short time. That is why the aim is usually a partial correction — with small doses, until the result is the one wanted, rather than complete clearing at the first visit.

Allergies and safety

• Allergic reactions are rare but possible. Tell your doctor in advance about any known allergies.
• The sooner there is a response to a problem, the better — do not wait for it “to settle” if there is severe pain, whitening or bluish discolouration of the skin.

Why it matters who places the filler

A doctor who places hyaluronic acid filler must have hyaluronidase available and know how to use it — this is part of the safety of the procedure itself.