They are a family of injectable enzymes that act as dispersing agents. These help 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 that it is being prescribed and administered in a manner different 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 benefit of the patient, his autonomy is respected and the patient has given his consent, hyaluronidase can be administered in case of 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 serious 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 an artery, this can cause the formation of a clot around the filling, or the filling itself can cause blockage.
If the vessel is important 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 region of the skin 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 extremely rare cases, blindness.
Fillers injected into an artery in the face can travel proximally to the internal carotid system so, when releasing the pressure, the product travels towards the central retinal artery resulting in loss or blindness .
Therefore, it is imperative that physicians recognize the signs of imminent necrosis and have the skills to be able to act quickly, thus reducing the risk of harm to the patient.
Not only must there be a policy that allows the professional to take care of the situation, but he must also be fully competent and have confidence in what he should do.
How is a treatment with hyaluronidase?
Vitrasebox hyaluronidase is injected, along with lidocaine (and sometimes epinephrine), into the area where the filler must dissolve. The injection is very easy 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 some reports that some people may be allergic to hyaluronidase, which happens to those who are allergic to bee stings.
The most common side effect is bruising, which can occur with any type of injection. Bruising should resolve within a week or two.
The most difficult 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 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 , the process of interstitial infusion or the subcutaneous infusion of fluids into the body.
It is important to note that if the doctor suspects 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 discoloration of the skin.
Throughout the procedure, the doctor should observe signs of skin whitening, a change in appearance that may appear dark or mottled.
In this case, the patient may complain of pain and the area may begin to feel cold to the touch. If these signs are ignored, the area 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 serious 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 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.
Patients should also be aware of the imminent risks associated with the use of hyaluronidase and that it is being used without a license.