The Use of Hyaluronidase in Aesthetic Practice: A Comparative Study of Practitioner Usage in Elective and Emergency Situations

Abstract

Background: Hyaluronic acids (HAs) continue to be the fillers of choice worldwide and their popularity is growing. Adverse events (AEs) are able to be resolved through the use of hyaluronidase (HYAL). However, routine HYAL use has been at issue due to perceived safety issues.

Objectives: There are currently no guidelines on the use of HYAL in aesthetic practice, leading to variability in storage, preparation, skin testing, and beliefs concerning AEs. This manuscript interrogated the use of this agent in daily practice.

Methods: A 39-question survey concerning HYAL practice was completed by 264 healthcare practitioners: 244 from interrogated databases and 20 from the consensus panel. Answers from those in the database were compared to those of the consensus panel.

Results: Compared to the database group, the consensus group was more confident in the preparation of HYAL, kept reconstituted HYAL for longer, and was less likely to skin test for HYAL sensitivity and more likely to treat with HYAL in an emergency, even in those with a wasp or bee sting anaphylactic history. Ninety-two percent of all respondents had never observed an acute reaction to HYAL. Just over 1% of respondents had ever observed anaphylaxis. Five percent of practitioners reported longer-term adverse effects, including 3 respondents who reported loss of deep tissues. Consent before injecting HA for the possible requirement of HYAL was always obtained by 74% of practitioners.

Conclusions: Hyaluronidase would appear to be an essential agent for anyone injecting hyaluronic acid filler. However, there is an absence of evidence-based recommendations with respect to the concentration, dosing, and treatment intervals of HYAL, and these should ideally be available.

Figure 1.

Comparison of consensus members and general respondents regarding skin testing before hyaluronidase treatment. Sixty-five percent of external practitioners would perform a skin test, vs 20% of the consensus practitioners. HCP, healthcare practitioner.

Figure 2.

Willingness to treat patients with bee sting allergies with HYAL. Ninety-one percent of the consensus group would administer hyaluronidase to those with bee or wasp sting allergy, vs only 52% of the external practitioners. HCP, healthcare practitioner.

Figure 3.

Percentage of respondents reporting acute reactions to HYAL. Ninety-two percent of respondents had not visualized an adverse acute reaction to HYAL, whereas 8% did to varying degrees.

Figure 4.

Years of experience in injection plotted against tendency to perform prospective skin testing indicates a much lower likelihood with greater experience. Fifty percent of those with 2 to 4 years’ experience would always perform such tests, vs 12% of those with experience of 10 years and above.