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They are a family of injectable enzymes that act as dispersing agents. This helps accelerate the natural breakdown of hyaluronic acid through hydrolysis.
Licensed for therapeutic indications, such as increased tissue permeability to improve the supply of medications or to increase the absorption of subcutaneous fluids, in aesthetics, it is widely used ‘without a license.’
The unauthorized license does not necessarily mean that it is not safe to use but is being prescribed and administered differently from its licensed use.
The license is obtained from the Medicines and Healthcare products Regulatory Agency (MHRA) and will indicate what the drug can be used for, how much to give, and the age of the patients who can be treated with it.
As long as the doctor acts for the patient’s benefit, his autonomy is respected, and the patient has given his consent, hyaluronidase can be administered in case of an adverse reaction.
Because of this ‘unlicensed’ use of hyaluronidase, doctors can only seek guidance from other professionals (as well as use their own experience) to judge how much hyaluronidase to use and how to reconstitute it, which can be limiting if you have little experience in your use.
Several factors will influence the administration and dosage, for example, the concentration of HA filler, the level of crosslinking, and the amount of HA deposit.
Recognizing complications with HA fillers
There are, of course, several complications associated with the administration of a dermal filler HA treatment, such as bruising, mild swelling, and sensitivity at the injection site, which can be easily managed through observation and support on behalf of the patient.
More severe complications, such as when injected into a vein or artery, will require medical intervention and administration of hyaluronidase as part of your treatment. If HA is injected into a route, this can cause the formation of a clot around the filling, or the filling itself can cause blockage.
If the vessel is essential in the supply of blood to the skin, this can lead to necrosis, an irreversible complication that causes the death of the skin tissue. This occurs when the skin region can not access enough blood and oxygen.
When injected into a vein, HA can also cause a blockage, which causes blood to flow back into the tissues and therefore increases pressure and causes low-grade ischemia.
The nose is one of the most feared sites for necrosis after HA procedures, with the tip being the most affected.
To give an example of how serious a vascular complication may be, injecting dermal filler into the angular vessels around the nose can potentially lead to skin blockage and necrosis or, in sporadic cases, blindness.
Fillers injected into an artery in the face can travel proximally to the internal carotid system. When releasing the pressure, the product travels towards the central retinal artery resulting in loss or blindness.
Therefore, physicians must recognize the signs of imminent necrosis and have the skills to act quickly, thus reducing the risk of harm to the patient.
There must be a policy that allows the professional to take care of the situation, but he must also be fully competent and confident in what he should do.
How is a treatment with hyaluronidase?
Vitrasebox hyaluronidase is injected with lidocaine (and sometimes epinephrine) into the area where the filler must dissolve. The injection is straightforward to tolerate for most people, but it can sting a bit, so lidocaine is used for numbing purposes to alleviate this sensation.
There have been reports that some people may be allergic to hyaluronidase, which happens to those allergic to bee stings.
The most common side effect is bruising, which can occur with injection. Bruising should resolve within a week or two.
The most challenging aspect of using hyaluronidase is calculating the amount needed to dissolve a certain amount of filler, so there may be an excess or a lack of dissolution, which means that you may have to go back to the office to perform the tests—follow-up procedures.
Remember that it is almost an art to remove the filler putty as it is to inject it in the first place.
What kind of results can I expect from a hyaluronidase treatment?
Hyaluronidase works very quickly, and most of the effect occurs in 24 hours. You should be able to see definite improvements and less filling in the injected area, starting in a few hours.
After a few days, if you still have areas that need correction, you may need another round of hyaluronidase or to add additional fill syringes. Remember that you can not perform hyaluronidase and add more filling in the same area on the same day.
When should it be used?
Excessive injection can be a potential risk when injecting HA fillings, leaving the patient with unsightly or “pillow-face” protuberances, with large volumes of filling visible in the middle of the face.
Nodules may also appear after AH anywhere on the face, and those that begin within 48 hours after the injection may be inflammatory.
However, those that occur sub-acutely (up to two weeks after treatment) or late (after two weeks) are more likely to involve infection. Large bruises can also be treated with hyaluronidase.
The use of hyaluronidase can improve absorption through hypodermoclysis, interstitial infusion, or the subcutaneous infusion of fluids into the body.
It is important to note that if the doctor suspects an infection, then hyaluronidase should not be used, and antibiotics should be administered. prescribed
However, another side effect that can be resolved with hyaluronidase is when the Tyndall effect occurs. This is when the HA is placed too superficially and creates a bluish skin discoloration.
The doctor should observe signs of skin whitening throughout the procedure, a change in appearance that may appear dark or mottled.
The patient may complain of pain, and the area may begin to feel cold to the touch. If these signs are ignored, the site may turn blue, and tissue necrosis may occur.
Hyaluronidase should be administered as soon as this complication occurs, and there is good evidence that tissue necrosis can be prevented or less severe the earlier the hyaluronidase is injected.
Hyaluronidase should be used early since its effectiveness in dissolving HA fillers is reduced after approximately four hours.
Whether the situation is an emergency or not, it is imperative that the patient fully understand the implications of why it is prescribed, how it will be administered, and a consent form must be signed.
