Dissolving hyaluronic acid

Dissolving hyaluronic acid is an aesthetic medicine treatment in which the doctor administers hyaluronidase — an enzyme that breaks down (depolymerizes) hyaluronic acid previously injected as filler. This makes it possible to reverse or correct a filling effect the patient does not accept, and to manage some complications following hyaluronic acid treatments.

Hyaluronidase acts selectively on the hyaluronic acid contained in the filler (and also, temporarily, on the natural hyaluronic acid of the tissues), speeding up its absorption. The enzyme has a relatively short duration of action in the tissues, which is why with a large volume or a heavily cross-linked product an additional dose after a few days is sometimes needed.

This is a strictly medical treatment. At the Dr Kuschill MEDESTETIS clinics (Krakow and Warsaw) dissolving hyaluronic acid is always preceded by a consultation and qualification, and at the first administration of hyaluronidase we perform an allergy test, because the enzyme can trigger an allergic reaction in some people.

We consider dissolving hyaluronic acid both in aesthetic situations and in medical complications. The most common indications are:

• excessive or unnatural filling (e.g. „overfilled” lips, too much cheek volume)
• asymmetry after filler administration
• palpable lumps and irregularities (nodules) at the injection site
• the Tyndall effect — a bluish discoloration of the skin over acid placed too superficially, especially in the eye area
• migration or improper distribution of the product
• a desire to fully reverse the effect before any correction

A separate, urgent group of indications is vascular complications — occlusion or compression of a vessel by the filler (symptoms such as severe pain, blanching of the skin, mottling, and in extreme situations visual disturbances). This is an emergency: hyaluronidase should be administered as quickly as possible, so if worrying symptoms appear after hyaluronic acid administration you must contact a doctor immediately.

The treatment begins with a consultation: the doctor determines which product was administered and when, assesses the area and plans the hyaluronidase dose. Before the first administration we perform an allergy test (intradermal administration of a small amount of the enzyme) and observe the skin's reaction.

The actual administration consists of injecting hyaluronidase with a fine needle into the sites where the hyaluronic acid to be dissolved is located. The doctor selects the dose individually — it depends on the indication (aesthetic or emergency), location, volume and degree of cross-linking of the filler. In emergency situations, such as a vascular complication, the enzyme is administered without delay and usually in higher doses.

After the treatment we observe the area. Part of the effect is visible almost immediately, but we usually make the full assessment and the decision on any repetition after a few days to about 1–2 weeks.

The effect is the breakdown and accelerated absorption of the previously administered hyaluronic acid — reducing excess volume, easing asymmetry and lumps, or resolving the Tyndall effect. In a vascular complication the goal is to unblock the vessel and limit the risk of tissue damage.

Dissolved filler does not „return”, so in that sense the treatment's effect is permanent. It is worth remembering that hyaluronidase also acts on the skin's natural hyaluronic acid, but the body quickly restores it. The effect depends on the type and amount of the previously administered product, so more than one session is sometimes needed — without a guarantee of achieving a specific result.

Care after dissolving hyaluronic acid is similar to the recommendations after other injections. We usually ask that you:

• do not touch or massage the treatment area for the first 24 hours (unless the doctor recommends massage)
• avoid the sauna, solarium, pool and intense exertion for 1–2 days
• do not apply makeup at the injection site for several to a dozen or so hours
• cool the area if swelling appears (as recommended by the doctor)
• observe the skin and report worrying symptoms (increasing pain, severe swelling, rash)
• wait until the time set by the doctor before any repeat filler correction

If symptoms of an allergic reaction appear after hyaluronidase administration (sudden itching, hives, swelling, difficulty breathing), you should contact the facility immediately or seek medical help.

Contraindications and situations requiring caution:

• pregnancy and breastfeeding
• active infection or inflammation at the planned treatment site (e.g. herpes)
• confirmed hypersensitivity to hyaluronidase or a positive allergy test result
• known allergy to hymenoptera venom (possible cross-reactivity)
• active autoimmune diseases
• clotting disorders or taking anticoagulant medication (individual assessment)

Note: in a vascular complication, which is an emergency, the doctor may decide to urgently administer hyaluronidase despite relative contraindications, weighing the benefits and risks. The final qualification is always carried out by the doctor during the consultation.