The use of hyaluronidase in the practice of a cosmetologist

Hyaluronidase is an enzyme that is capable of breaking down acidic mucopolysaccharides (hyaluronic acid) into low molecular weight fragments. Hyaluronidase activity is calculated in international units (IU).

In the literature, the first mention of hyaluronidase was made in 1928 by F. Durand-Reynal. Until recently, hyaluronidase isolated from the testes of cattle was used. Today, recombinant hyaluronidase (of non-animal origin) has appeared.

But, in addition to hyaluronidase, many specialists also use lidase and longidase.

Lidase is an enzyme whose specific substrate is hyaluronic acid, which has a high viscosity and “cements” the intermediate substance of connective tissue. The effect of hyaluronidase is reversible - a decrease in concentration restores the viscosity of hyaluronic acid.

Lidase 64 IU is diluted in 2 ml of saline solution. For one procedure, you can use from 0.1 ml to 1.0 ml of lidase (depending on the problem). Experts use lidase much less frequently, since it is the one that most often can cause an allergic reaction.

The next product, which is also applicable in practice, is longidase. It is a conjugate of the proteolytic enzyme hyaluronidase with a high-molecular carrier from the group of poly-1,4-ethylenepiperazine N-oxide derivatives. Upon administration, it is quickly absorbed into the systemic circulation and reaches maximum concentration in the blood after 20-25 minutes.

Longidase 3000 IU is diluted in 2 ml of physiological solution. The amount of drug administered also depends on the clinical picture. In practice, it is used much more often, since the product is of a higher degree of purification than lidase.

Hyaluronidase 1500 IU is a lyophilized form, does not contain preservatives and is diluted in 4 ml of saline. Thus, 1 ml of solution contains 375 IU of hyaluronidase; 0.5 ml - 187 IU; 0.1 ml - 37.5 IU. It is easier to calculate when we dilute hyaluronidase in 5 ml of physiological solution. Then in 1 ml of solution - 300 IU; at 0.5 - 150 IU; at 0.1 - 30 IU.

To eliminate overcorrection, sometimes it is enough to inject hyaluronidase literally at the tip of the needle. In emergency situations, 500 IU of hyaluronidase is injected into the ischemic area every hour until the patient’s condition improves.

A dose of 500 IU of hyaluronidase is considered safe when administered simultaneously.

The most common areas of overcorrection are on the face, after the introduction of hyaluronic acid fillers, which we eliminate using hyaluronidase. These are the nasolacrimal groove, lips, “rings of Venus” in the neck, nasolabial folds and temporal region, forehead area. Hyaluronidase is indispensable for ischemia or vascular occlusion.

Contraindications for administration: allergic intolerance to the drug, cancer, pregnancy and breastfeeding, acute inflammatory and injection diseases, respiratory failure.

The administration of hyaluronidase of animal origin may cause allergic reactions of both delayed and immediate types. Therefore, the office must have an anti-shock kit, and before the procedure we conduct an allergy test.

Before performing the test, giluronidase 1500 IU is diluted in 8 ml of physiological solution. Thus, 1 ml of diluted hyaluronidase will contain 150 units. Then we inject 0.1 ml of the diluted solution subcutaneously into the forearm area, first marking the injection site with a white pencil. The patient is under our supervision for an hour. A follow-up examination is carried out after 72 hours. Any manifestations of an allergic reaction at the injection site are regarded as a contraindication for treatment (increased hyperemia, swelling, itching). In such cases, the procedure is not carried out. And the patient is given 8 mg of dexamethasone intramuscularly.

The diluted hyaluronidase solution is stored for 24 hours.

First published: Cosmetologist No. 3, 2017