How does dermal filler reversal with hyaluronidase (hyalase) work?
Hyalase works by breaking down bonds between dermal filler molecules in a process called hydrolysis. The byproducts of this breakdown are then metabolised and removed harmlessly from the body.
How quick does hyalase work?
Immediately.
Hyalase has a half life of 2 minutes, but a duration of action of 24-48 hours. Swelling is common and lasts to a noticeable extent 2-3 days. All swelling should have resolved by 2 weeks, whereby it is acceptable to re-treat with dermal filler provided there is no persisting medical complication.
When can I reinject dermal filler after having hyalase reversal?
We suggest you wait 2 weeks prior to retreatment. This ensures all swelling post hyalase reversal has resolved. Injecting within 2 days of hyalase will result in reversal of the new filler also.
Is hyalase dermal filler reversal painful?
It can be if not properly mixed pre injection. Hyalase comes as a powder that needs to be reconstituted prior to injection. At Contour Clinics, we use a mixture of local anaesthetic and pH neutralising solution to remove any pain associated with injection.
It is our experience that some of our patients who have previously had hyalase reversal elsewhere recount severe pain during their prior reversal. This is a common story. Ensure your injector is utilising the
How much hyalase will I need?
This will be determined by your cosmetic injector at the time of your consultation. Factors to be considered in this determination are:
- Amount of filler required to be reversed
- Concentration of Hyaluronic acid/ml of dermal filler – thicker fillers have higher concentrations
- Degree of dermal filler cross-linking – more cross links the higher likelihood more hyalase will be required
- Degree of cosmetic deformity- small concerns can be treated with ‘micro hyalase’ to reverse the problem area rather than all of your filler.
If you are unsure about what your previous injector has used, we usually judge based on the area treated. Bony areas usually have higher amounts of hyaluronic acid per ml and greater degree of cross linking. Hence filler in these areas likely need larger doses of hyalase.
What are the common reasons for reversal of dermal filler?
The common reasons for reversal of dermal filler include:
- Product migration
- Dermal filler will move to the path of least resistance. This is common in the lips where dermal filler can extend upwards outside of the lip border.
- Lumps and bumps
- This are common in the lips and tear trough (under eye) regions as soft skin is unforgiving in this area and lumps and bumps are easily visible
- Tyndall effect
- This is a blue hue visible when dermal filler is placed too close to the skin
- Emergency reversal
- In the event a blood vessel is blocked during dermal filler treatment immediate reversal must be instituted. Review must be performed the day post to decide whether further reversal is required.
