Hyaluronidase: Dissolving Hyaluronic Acid Fillers

Hyaluronidase is an enzyme that breaks down hyaluronic acid (HA). When injected into areas previously treated with HA fillers, it dissolves the filler — the key reversibility advantage of HA over other fillers. This is both a safety tool (for emergency vascular occlusion) and an elective correction tool (for over-correction or unwanted results).

Indications for Hyaluronidase

Emergency Use (Vascular Occlusion)

The most critical indication. If HA filler blocks a blood vessel — causing skin blanching, pain or impending necrosis — immediate high-dose hyaluronidase injection is the treatment. Every practice offering HA fillers must have hyaluronidase immediately available.

Elective Correction

Over-filling or unnatural appearance ("pillow face")
Asymmetry between the two sides
Tyndall effect (blue-grey discolouration under thin skin)
Migration of filler to unintended areas
Patient requesting complete removal before new treatment

Procedure

Hyaluronidase (Hyalase, Vitrase, or compounded formulations) is injected directly into the filled area. Effect is visible within 24–48 hours. Multiple sessions may be needed for complete dissolution of thick or old filler.

Risks

Allergic reaction (rare — skin prick test recommended in allergy-prone patients)
Over-dissolution — more filler removed than intended
Temporary localised oedema