Hyaluronidase - an integral element in the office of a cosmetologist

Olena Chergava , PhD, Lecturer at the Department of Maxillofacial Surgery and Dentistry, Ukrainian Military Medical Academy

Contour plastic has become one of the most popular procedures in the office of a cosmetologist. As a result, a higher percentage of complications after manipulations. That is why the primary condition for a calm, high-quality, creative work of a doctor as if on a clean canvas with drugs based on HA is the presence of a direct antidote in the clinic. So in contour plastic there is hyaluronidase .

Hyaluronidases are a family of hydrolase enzymes that catalyze the degradation of hyaluronic acid . The action of hyaluronidase leads to an increase in tissue permeability and facilitates the movement of fluid in the intercellular space . These drugs have been used in medicine for over 60 years. Hyaluronidases, which are currently used in medicine, are either of animal origin or recombinant type.

Indications

There are three main groups of side effects caused by hyaluronic acid fillers that are treated with hyaluronidase. Namely: overcorrection or too superficial administration of HA, inflammatory or non-inflammatory nodes, as well as acute conditions associated with vascular occlusion. We would like to note that acute conditions and severe complications are extremely rare. But the management of such situations requires a deep study of the issue and detailed coverage. And hypercorrections, nodes and unsatisfactory aesthetic appearance of certain areas after contouring with the use of HA preparations are quite common and require an injection doctor to have basic knowledge in this area and their frequent use in everyday practice.

Preparation of the preparation

Hyaluronidase can be reconstituted with saline or water for injection. Saline is less painful to inject and is therefore recommended for this reason.

Reconstitution of the drug is carried out immediately before the procedure. Usually, from 1 to 10 ml of “liquid-solvent” is added to the preparation (most often the golden mean is 4-5 ml). Based on the formula (Table 1), the doctor can easily calculate the number of units planned for administration.

Tab.1

For acute conditions associated with vascular blockage, the initial dose is 150-200 units. And this amount of the drug is administered, as a rule, several times.

To correct excessive volumes or knots, the dosage is usually only 10-30 units.

There is also a general rule of thumb: for every 0.1 ml of HA that needs to be dissolved in the tissues, the doctor must use at least 5 units of hyaluronidase.

Introduction

Before the introduction of the drug should make a test.

"Injection-check" is 3-4 units of hyaluronidase intradermally on the inner surface of the forearm. After that, observe the condition of the tissues for 15-20 minutes. Slight redness is a common tissue reaction to injury. But swelling, intense redness and a rash around are a marker of an allergic reaction.

Before injection, the site should be inspected, palpated and, if necessary, marked. The site must be cleaned and disinfected with an appropriate skin solution and the procedure carried out using aseptic technique. To treat the depth of the site, a 27 or 30 G needle with the appropriate length should be used. The introduction should be precise and limited to the affected area. Depth can be difficult to assess on palpation, so injections should include the upper and lower limits of the HA preparation that was administered previously.

During and after the procedure, the treated area should be vigorously massaged to optimize the result and help mechanical breakdown of the HA.

The effect of injections will be visible after 48 hours. And repeated contour plastic surgery, if desired, can be carried out in two weeks.

As an example, the photo shows a multi-stage procedure to restore the aesthetic shape of the upper lip.

The first step was to break down the hyaluronic acid in the lips with the help of the enzyme hyaluronidase. And the second - repeated contouring with a preparation based on HA in a volume of 0.5 ml after 15 days.

conclusions

Hyaluronidase is a drug that effectively and quickly removes HA-based fillers from tissues. This enzyme has been sufficiently studied and makes it possible in a short time to return visual volumes, the appearance of soft tissues to the initial situation. Such properties of this drug make it uniquely indispensable in the office of every injection doctor.

Literature:

1. Brody H.J. The use of hyaluronidase in dosages of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement. Dermatol Surg 2005;31:893-7.
2. DeLorenzi C. Complications injectable fillers, part I. Aesthet Surg J 2013;33:561–75.
3. Hirsch RJ, Brody HJ, Carruthers JDA. Hyaluronidase in the office: A must for all dermatologists that have hyaluronic acid injections. J Cosmetic Laser Ther 2007; 9:182-5.
4. Rzany B, Becker-Wegerich P, Bachmann F, Erdmann R, et al. Hyaluronidase in hyaluronic acid-based fillers correction: a review and a recommendation for use. J Cosmetic Dermatol 2009; 8:317–23.
5. DeLorenzi C. Complications of injectable fillers, part 2: vascular complications. Aesthet Surg J 2014; 34:584-600.
6. DeLorenzi C. Transarterial degradation hyaluronic acid filler by hyaluronidase. Dermatol Surg 2014;40:832–41.

Photos provided by the author of the article.