title: Hyaluronidase Caveats in Treating Filler Complications.
abstract: BACKGROUND
  Most of the complications associated with hyaluronic acid (HA) fillers can be addressed by hyaluronidase. Extensive experience with this enzyme was accumulated in ophthalmology and anesthesia. In dermatologic use multiple aspects still remain controversial.
  
  
  OBJECTIVE
  To elucidate questions with regard to hyaluronidase use in HA-induced complications, including appropriate dosage, timing, and technique of delivery, differences in the activity of hyaluronidases of different origins, interaction between the enzymes and different HA gels, and safety issues.
  
  
  METHODS
  Extensive review of the relevant literature was conducted. The conclusions are based on this review and personal author's experience.
  
  
  RESULTS
  FDA-approved hyaluronidases provide predictable results and can be used interchangeably. A physician has to be closely familiar with specific characteristics of other hyaluronidases. Different brands of HA fillers have different sensitivity to degradation by hyaluronidase. For filler overcorrection or misplacement, low dose of the enzyme has to be injected directly into the palpable HA mass. In case of vascular accident, flushing of the ischemic area with high doses of hyaluronidase is required. Hypersensitivity reactions to hyaluronidase are so far not reported in dermatologic literature.
  
  
  CONCLUSIONS
  With increased popularity of HA fillers, hyaluronidase had become an indispensable tool in dermatology office. It is safe and reliable for treatment of HA-induced complications.
authors.affiliation: Dermatology Unit, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Marina
authors.initials: M
authors.lastname: Landau
mesh_terms: D003357:Cosmetic Techniques / Q000009:adverse effects*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use*; D007267:Injections
chemical_list: D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase