What Is Hyaluronidase?
Hyaluronidase is a prescription enzyme that breaks down hyaluronic acid, and clinicians inject it to dissolve hyaluronic acid (HA) dermal fillers. The FDA approved it to help the body absorb fluids and injected drugs. Using it to dissolve filler is an off-label use, and your provider should tell you that before treatment.
HA fillers are the most commonly used dermal fillers, and they typically last 4 to 12 months. Hyaluronidase makes them reversible, an advantage over calcium hydroxylapatite, poly-L-lactic acid and PMMA fillers.
Hyaluronidase at a Glance
| Types | Human recombinant (Hylenex) or products made from cow (bovine) or sheep (ovine) testes |
|---|---|
| What it treats (off-label) | Unwanted HA filler results, lumps and nodules, a bluish tint from filler, and filler blocking a blood vessel |
| How it works | Splits the chemical bonds in hyaluronic acid so the gel breaks apart |
| How it's given | Small injections with a thin needle into and around the filler |
| How fast it works | Often almost immediately. Final results can take up to 2 weeks. |
| Side effects | Redness, swelling, itching or pain where it was injected. Allergic reactions are rare. |
| FDA status | FDA-approved drug (Hylenex first approved in 2005). Dissolving filler is off-label. |
What Is Hyaluronidase Used For?
Hyaluronidase is used in aesthetic medicine to dissolve HA filler, both by choice and in emergencies, for:
- Unwanted results: too much filler, misplaced filler or uneven results
- Lumps and nodules, including ones that appear months later
- Tyndall effect: a bluish tint, most often under the eyes
- A reaction to the filler that doesn't settle with antihistamines or steroids
- Vascular occlusion: filler blocking a blood vessel, which is an emergency
HA filler has been dissolved as long as 63 months after it was injected.
How Does Hyaluronidase Work?
Hyaluronidase works by cutting the bonds that link the sugar units of hyaluronic acid, which breaks the filler gel apart. HA fillers are cross-linked so they last longer. More cross-linking and a higher HA concentration make the filler harder to dissolve.
In a lab study of 21 HA fillers, Restylane-L, Restylane Lyft and RHA 1 were the least resistant. Juvéderm Voluma, Juvéderm Volux and RHA 4 were among the most resistant and required 120 units of hyaluronidase per 0.2 mL of filler.
The enzyme is short-lived. When injected into a vein, its half-life in human blood is 2 to 3 minutes. Because the body breaks it down quickly, enough of it has to be injected close to the filler.
What to Expect From Hyaluronidase Treatment
Hyaluronidase treatment is a short in-office injection visit.
Before
Your provider reviews your medical history, medicines and allergies, including reactions to bee or wasp stings. Some providers do a small forearm skin test. Its value is debated, and it is skipped when filler is blocking a blood vessel.
During
After optional numbing cream, the provider injects hyaluronidase with a thin needle and may massage the area. Treating the lips takes about 10 to 15 minutes.
After
- One guideline advises staying in the clinic for 60 minutes to watch for a reaction.
- Swelling and bruising can last up to a week, but you can return to normal activities right away.
- Lip filler can usually be dissolved in one or two visits. For non-emergency treatment, one guideline says repeat sessions can be given 48 hours or more apart.
Hyaluronidase Side Effects and Warnings
Hyaluronidase side effects are usually mild and limited to the injection site, most often redness and pain. Also know about:
- Allergic reactions: hives or swelling (angioedema) occur in less than 0.1% of patients, per the FDA label. Delayed reactions can appear after 24 hours, and a skin test may not predict them.
- Volume loss: the enzyme also breaks down some of your own hyaluronic acid, so the area may look thinner for a while.
- Medicine interactions: large doses of aspirin, cortisone, estrogens or antihistamines may mean more enzyme is needed.
- Recent Botox: one guideline advises waiting 48 hours after botulinum toxin in the same area, unless filler is blocking a blood vessel.
Who Shouldn't Have Hyaluronidase?
- People allergic to hyaluronidase or its ingredients
- Infected or acutely inflamed skin, because the enzyme can spread infection
- People with a history of allergic reactions to bee or wasp stings, who face a higher allergy risk
- Pregnancy or breastfeeding, unless you discuss it with your provider first, because it hasn't been well studied
When Is Hyaluronidase an Emergency Treatment?
Hyaluronidase is the main treatment when HA filler blocks a blood vessel. The FDA calls accidental injection into a blood vessel the most serious filler risk, because it can cause tissue death, blindness or stroke. One guideline estimates the risk of impending tissue death at 0.001% (1 in 100,000) of treatments.
Clinicians give high, repeated doses as soon as possible. Vision loss needs hospital care at once, because blood flow to the retina must return within 60 to 90 minutes. Seek immediate care for unusual pain, vision changes, white, gray or blue skin, or stroke signs during or shortly after filler.
Hyaluronidase vs. Waiting or Other Removal Options
Hyaluronidase dissolves HA filler within minutes to days, while waiting lets HA filler break down on its own over several months, and fillers not made of HA may need injections or surgery to remove.
| Works on | Timeline | Key points | |
|---|---|---|---|
| Hyaluronidase | HA filler only | Minutes to 2 weeks | Off-label. Small allergy risk. Can also thin your own hyaluronic acid. |
| Waiting it out | HA filler (lasts 4 to 12 months) | Several months | Not an option for a blocked blood vessel |
| Other removal methods | Calcium hydroxylapatite, poly-L-lactic acid, PMMA and silicone fillers | Varies | Removal may need injections or surgery and can be difficult or impossible. |
Hyaluronidase at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a provider evaluates your filler concern, including your filler type and allergy history. Based on that evaluation, your provider recommends treatment at GENEVA or a referral to a specialist.
Learn more about dermal fillers at GENEVA and lip filler. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
- Hyaluronic Acid Filler
- Dermal Fillers
- Lip Augmentation
- Tear Trough Treatment
- Juvéderm
- Restylane
- Radiesse
- Allergic Reaction
- Non-Surgical Chin Augmentation | Dermal Filler Chin Enhancement
Hyaluronidase FAQs
Is hyaluronidase safe?
Hyaluronidase usually causes only mild side effects, such as redness, swelling, itching or pain at the injection site. The FDA label reports hives or angioedema in less than 0.1% of patients, and studies report allergic reactions in 0.05% to 0.69%. Rare anaphylactic-like reactions have been reported after injections behind the eye or into a vein. People with a history of allergic reactions to bee or wasp stings face a higher risk, so tell your provider about any past sting reaction before treatment.
How long does it take hyaluronidase to dissolve filler?
Hyaluronidase often starts working almost immediately, but final results can take up to 2 weeks. Denser, more cross-linked fillers may take 48 hours to respond, and some fillers resist the enzyme more than others. Lip filler can usually be dissolved in one or two visits, but a large amount of filler or a nodule may need more. For non-emergency treatment, one guideline says repeat sessions can be given 48 hours or more apart. Swelling can last up to a week, so judge results after it settles.
Can hyaluronidase dissolve all fillers?
No, hyaluronidase dissolves only hyaluronic acid fillers. It can dissolve HA filler wherever it was placed, including the lips, cheeks and lower eyelids. It does not dissolve fillers made of calcium hydroxylapatite, poly-L-lactic acid, PMMA or silicone. The FDA notes that removing fillers not made of hyaluronic acid, especially permanent ones, may require injections, surgery or other procedures and can be difficult or impossible. If you aren't sure what filler you had, ask the office that injected it.
Does hyaluronidase dissolve your natural hyaluronic acid?
Yes, hyaluronidase can break down some of your body's own hyaluronic acid in the treated area, not just the filler. One guideline notes the enzyme may break down natural hyaluronic acid more readily than cross-linked filler. As a result, the area may look thinner and show fine lines, indentations or sagging after treatment. This thinning may be temporary, because the body usually replaces lost hyaluronic acid. If only one spot bothers you, a smaller amount can partially dissolve the filler.
How soon can you get filler again after hyaluronidase?
Cleveland Clinic advises waiting at least 14 days after hyaluronidase before redoing lip filler, because dissolved filler can take up to two weeks to fully break down. The enzyme itself is short-lived. A rat study found it lost its effect in the skin within 3 to 6 hours, and filler reinjected 6 hours later returned to almost its original volume. Swelling and bruising can last up to a week, so ask your provider when to reassess.
Can a primary care provider give hyaluronidase?
A primary care provider can evaluate a filler problem, but hyaluronidase should be injected only by a licensed provider trained in fillers, and you can't dissolve filler at home. The FDA advises choosing a provider experienced with fillers who knows facial anatomy and how to manage complications. At GENEVA in Alpharetta, a provider evaluates your filler concern and allergy history, then recommends treatment at GENEVA or a referral to a specialist. For sudden pain, skin color changes or vision changes after filler, seek emergency care right away.