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Review
. 2021 Aug;14(8):E69-E75.
Epub 2021 Aug 1.

Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol

Gillian Murray  1   2   3   4   5 , Cormac Convery  1   2   3   4   5 , Lee Walker  1   2   3   4   5 , Emma Davies  1   2   3   4   5
Affiliations
Review

Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol

Gillian Murray et al. J Clin Aesthet Dermatol. 2021 Aug.

Abstract

Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for the patient. Hyaluronidase is an enzyme that was first used in general medicine in 1949, but has gained widespread use in aesthetic medicine to dissolve hyaluronic acid (HA)-based dermal fillers. Knowledge of this drug and its use for other aesthetic indications is evolving, and there is often anxiety attached to the administration of animal-derived product due to fears of an allergic reaction. This paper provides guidance on the indications for use when dissolving HA filler with hyaluronidase. It discusses formulation differences, adverse events, allergy to wasp and bee stings, and how this increases risk of allergy to hyaluronidase. It also discusses incidence of allergy, which includes a discussion of types of allergic response and how this correlates to skin tests and a discussion on skin testing for allergy.

Keywords: DON; Hyaluronidase; cross-linked hyaluronic acid; delayed inflammatory reaction; delayed-onset nodule; dermal filler; elective dissolution; high-dose protocol; hyaluronic acid; hylenex; vascular occlusion.

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Conflict of interest statement

DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article.

Figures

FIGURE 1.
FIGURE 1.
Common bees and wasps in the Hymenoptera order; adapted from: Bonadonna P, Scaffidi L. Hymenoptera Anaphylaxis as a Clonal Mast Cell Disorder. Immunol Allergy Clin North Am. 2018;38(3):455–468.
See this image and copyright information in PMC

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