Hyaluronidase
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Hyaluronidase is an enzyme that breaks down hyaluronic acid, a polysaccharide naturally occurring in the skin, subcutaneous tissue, joints, and many other structures of the human body. In medicine, it is primarily used to accelerate the degradation of cross-linked hyaluronic acid used in aesthetic procedures. Preparations containing hyaluronidase are used both in the treatment of complications following filler administration and in the correction of undesirable aesthetic effects. Modern aesthetic medicine considers hyaluronidase to be one of the most important safety tools, especially in situations requiring the rapid removal of excess product or the restoration of proper tissue blood supply.
Hyaluronidase - what is it
Hyaluronidase belongs to a group of hydrolytic enzymes that break down chemical bonds present in hyaluronic acid molecules. Under physiological conditions, enzymes of this type participate in the natural metabolism of the extracellular matrix, being responsible for tissue remodeling and regeneration.
In medicine, hyaluronidase preparations of animal or recombinant origin are used. Their role is the controlled dissolution of hyaluronic acid previously administered in the form of fillers.
Hyaluronidase plays a particular role in aesthetic medicine, as most modern facial contouring preparations are based precisely on stabilized hyaluronic acid. The enzyme enables partial or complete removal of the administered preparation, which significantly increases the safety of procedures.
The most important properties of hyaluronidase:
- breaks down cross-linked hyaluronic acid;
- increases tissue permeability;
- accelerates the absorption of swelling;
- enables the correction of asymmetry;
- helps in the treatment of vascular complications;
- allows the reversal of undesirable aesthetic effects.
It should be emphasized that hyaluronidase acts exclusively on preparations containing hyaluronic acid. It does not remove other types of fillers, such as calcium hydroxyapatite, polycaprolactone, or silicone.
Hyaluronidase - application
The scope of applications of hyaluronidase in aesthetic medicine is very broad. It is most commonly used to correct undesirable results after volumizing procedures and to treat complications requiring immediate intervention.
The most important indications include:
- excessive volume after filler administration;
- facial asymmetry;
- hyaluronic acid migration;
- lumps and irregularities under the skin;
- the Tyndall effect;
- chronic swelling;
- compression of blood vessels;
- tissue ischemia;
- preparation for facial remodeling.
The use of hyaluronidase in the treatment of vascular occlusion caused by hyaluronic acid is of particular importance. This is a rare, but potentially very serious complication that can lead to skin necrosis, and in exceptional cases, even to vision impairment.
In ophthalmology, surgery, and anesthesiology, hyaluronidase is also used to increase the diffusion of drugs in tissues and to accelerate their absorption.
Indications for the use of the enzyme should always be evaluated individually by a physician experienced in facial anatomy and aesthetic medicine.
Hyaluronidase - how it works
The mechanism of action of hyaluronidase is based on the enzymatic cleavage of β-1,4-glycosidic bonds present in hyaluronic acid molecules. As a result, long polysaccharide chains break down into smaller fragments, which are then gradually eliminated by the body.
Following the administration of the product, the following occurs:
- contact of the enzyme with hyaluronic acid molecules;
- breakdown of the cross-linked structure of the filler;
- reduction in the volume of the product;
- increase in tissue permeability;
- initiation of natural metabolic processes.
The speed of action depends on many factors:
- the type of filler used;
- the degree of cross-linking of the hyaluronic acid;
- the amount of product administered;
- the dose of the enzyme;
- the injection site;
- the individual characteristics of the patient.
The first effects may appear after just a dozen or so minutes, but the full result is usually assessed after 24-72 hours. In some cases, repeating the procedure may be necessary.
It is of significant importance that hyaluronidase can affect not only artificially administered hyaluronic acid, but also partially the acid naturally present in the tissues. For this reason, dosing requires high precision and a very good knowledge of anatomy.
Hyaluronidase - effects
The effects of using hyaluronidase depend on the clinical indication, the enzyme dose, and the type of product being dissolved. In most cases, the goal of the procedure is to restore natural facial proportions or quickly resolve complications.
The most commonly observed results include:
- reduction of excessive tissue volume;
- reduction of asymmetry;
- removal of lumps and irregularities;
- elimination of the Tyndall effect;
- reduction of swelling;
- improvement of skin blood supply;
- restoration of proper facial contours.
Following the procedure, transient swelling, redness, tenderness, or minor bruising may occur. These symptoms usually resolve spontaneously within a few days.
In the case of treating ischemia, the effectiveness of therapy depends primarily on the timing of enzyme administration. The sooner hyaluronidase is applied, the greater the chance of avoiding permanent tissue damage.
It is worth remembering that after the filler is completely dissolved, a temporary impression of volume loss may appear, resulting from the removal of both the product and the accompanying swelling.
Hyaluronidase treatments
Hyaluronidase is primarily used as a corrective procedure after treatments involving hyaluronic acid. It is most commonly performed after lip modeling, facial volumetry, nose correction, treatments in the tear trough area, and jawline and chin modeling.
The most common situations requiring the use of hyaluronidase include:
- correction of overfilled lips;
- removal of hyaluronic acid from the tear trough;
- elimination of facial asymmetry;
- nose correction after non-surgical modeling;
- preparation for repeat volumetry;
- treatment of the Tyndall effect;
- treatment of vascular complications.
The procedure involves administering an appropriately selected dose of the enzyme directly into the area where the hyaluronic acid is located. Depending on the clinical situation, the procedure may require a single intervention or several therapeutic sessions.
Every application of hyaluronidase should be preceded by a thorough medical history, an analysis of the type of product previously used, and an assessment of the potential risk of hypersensitivity reactions.
