Indications for Elective Hyaluronidase Treatment

Tyndall effect

The Tyndall effect refers to the scattering of light that may be seen in some patients after injection of HA resulting in a bluish hue of the skin and most commonly seen in the sub ocular region. The problem can be resolved using hyaluronidase 

Unacceptable/unsightly cosmetic outcome

Overcorrection or misplacement of HA filler can be successfully treated with hyaluronidase, although this is often caused by poor injection technique or poor choice of product for a particular indication. If HA is present, then hyaluronidase is effective.

Delayed onset nodules

Lumps or nodules that appear several months after the initial treatment might be amenable with hyaluronidase. It is important to remember that hyaluronidase is used to help diffuse fluids intradermally and for hypodermoclysis. To prevent potential dissemination of infection in inflammed nodules, it is important to prescribe antibiotics for one week before administering hyaluronidase.

Allergic or immunogenic reaction to the HA dermal filler

When an allergic, immunogenic, or sensitivity reaction occurs and does not settle on its own within an acceptable amount of time following a short course of antihistamines or systemic corticosteroids, removal of the filler with hyaluronidase is appropriate. If the reaction is considered moderate or severe, oral corticosteroids should be taken before hyaluronidase use to manage or prevent the potential initial worsening of symptoms due to the increase in antigens as the HA is broken down.

***Most clients presented with overfilled/lumpy lower eyelids post tear troughs treatment and “ducky & lumpy” lips with or without extensive HA migration into tissues.