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Some of the most common dermal fillers include those made of hyaluronic acid, a natural substance that can last from a few months up to one year. Popular hyaluronic acid fillers include Juvederm Ultraplus, Restylane® , Perlane, Juvederm®  Voluma & Belotero. Hyaluronic acid dermal fillers are a fabulous treatment for a variety of cosmetic concerns, as hyaluronic acid is able to boost volume in the soft tissue and create natural-looking, revitalizing facial contouring. However, sometimes are dissatisfied with their hyaluronic acid filler results, particularly if their injector was inexperienced.

If you are dealing with an overdone or unhappy with your dermal filler results, hyaluronidase injections with Dr. Green can reverse the effects of these hyaluronic acid injectables. Hyaluronidase can also be injected if there was an allergic reaction to the filler. The results from Hyaluronidase injections occur within 2 to 3 days and will dissolve the previously injected filler, though sometimes a second treatment with hyaluronidase is necessary to reverse the full effects.

Overall, if you are looking to dissolve past injections of Restylane or Juvederm, hyaluronidase injections may be a solution for you. One of the benefits of treatments like Juvederm and Restylane is that the effects of the treatments are entirely reversible through the use of hyaluronidase. They can be easily reversed via this dissolving process at any later date, even months down the road – and with far fewer injections needed.

For Hyaluronidase procedures in NYC, Dr. Michele Green is an expert in various dermal filler and reversing improper cosmetic injections of hyaluronic fillers.  It is important to inject the correct amount and location of hylauronidase and thus have an expert dermatologist who can determine the right amount needed. Dr. Green has over 25 years of experience in cosmetic dermatology and is considered one of the best cosmetic injectors in NYC. Her boutique New York practice treats patients from NYC, but internationally as well. If you need correction of misplaced dermal filler or improper injection technique, Dr. Green can reverse these unwanted results.

N.S Before and After Vitrase 3 sessions MGWatermark

What is Hyaluronidase?

Hyaluronidase is an enzyme solution that is marketed with several FDA-approved brand-name formulations, including Hydase, Hylenex, Amphadase and Vitrase.

Vitrase is injected into the same area of the tissue as the hyaluronic acid product (Juvederm, Restylane, Belotero) was injected previously. Hyaluronidase injections are used to break down or reverse these products and works fairly quickly, usually within 24 hours. Sometimes it may be necessary to return for a second or third injection. It does not work on non-hyaluronic fillers, such as Radiesse or Sculptra, and you will need to discuss options with Dr. Green beforehand, as results vary per patient.

Hyaluronidase is an enzyme that occurs naturally in the body, and it is produced by white blood cells in order to move more quickly through connective tissues in the body. Hyaluronidase enzymes have been discovered in insects,  mammalian tissues, and even snake venom. There are a variety of different hyaluronidase classifications, with the most common being Hyal1 and Hyal2. Hyaluronidase activity within Hyal2 has less enzyme activity, but is in fact able to breakdown hyaluronic acid with a higher molecular weight. Within hyaluronidase injections, this enzyme is typically collected from purified bovine tissue (ovine testicular hyaluronidase), or derived from human albumin sources (recombinant human hyaluronidase).

What is hyaluronic acid?

Hyaluronic acid, also known as hyaluronan, is a naturally occurring substance in the body that is designed to stimulate collagen production in the body. It’s a glycosaminoglycan, which is considered a major component of the extracellular matrix, as it links together collagen fibers, connective tissue, and protein filaments in the body. Hyaluronic acid is formed by a polymer of two primary disaccharides , D-glucuronic acid and D-N-acetylglucosamine. Hyaluronic acid filler injections are commonly used to boost the volume of the skin via subcutaneous injections, and the majority of hyaluronic acid fillers use hyaluronate cross-linking technology. These linkages connect hyaluronic acid molecules with a plasticizing agent for optimal facial contouring.

Essentially, hyaluronic acid fillers rely on the natural collagen production that occurs in the body, and create targeted new collagen growth within the treatment area. Dr. Green uses hyaluronic acid filler to treat a variety of cosmetic concerns, including:

  • The reduction of fine lines and wrinkles in the eye area
  • The reduction of fine lines and wrinkles around the mouth, including marionette lines, smile lines, and perioral lines
  • Lip augmentation
  • Check enhancement
  • Correction of age-related volume loss in the midface
  • Correction of age-related volume loss under the eyes to reduce the appearance of dark circles or under-eye bags
  • Volume loss in the hands
  • Fine lines and wrinkles in the neck

Popular hyaluronic acid filler brands include the Juvederm line of hyaluronic acid filler products, the Restylane line of hyaluronic acid filler products, and Belotero dermal filler. Dr. Green tailors each of her hyaluronic acid dermal filler treatments to best meet the concerns of each patient, using an artful, “less-is-more” approach to her filler injections.

Oftentimes, Dr. Green will meet with patients who have gone to inexperienced dermal filler injectors, and are dissatisfied with their results. Inexperienced injectors are common in places like medical spas, where oftentimes consultations and/or injections are not done by a board-certified medical professional. Dr. Green always recommends you google and do your research when it comes to hyaluronic acid fillers, and works to make sure all of her patients are satisfied with her facial contouring procedures. For patients who come to her frustrated by a previous hyaluronic acid filler experience, she is able to offer hyaluronidase treatment, which can dissolve the effect of overdone or unwanted hyaluronic acid filler results.

hyaluronidase 1156967047

What does Hyaluronidase do?

Hyaluronidase is able to break down the hyaluronic acid links within dermal filler injections. The injection of hyaluronidase (Hyal1/2) is able to kickstart the hydrolysis of hyaluronic acid, which in turn can lower the viscosity of hyaluronic acid and increase tissue permeability. Through this process, the role of hyaluronidase is used within hyaluronidase injections in order to target the hyaluronic acid linkages created by a hyaluronic acid filler.

Hyaluronidase is able to completely reverse the results of hyaluronic acid fillers within as little as one treatment. Unfortunately, hyaluronidase injections cannot effectively be used on other dermal filler formulations, such as that of Calcium Hydroxylapatite (Radiesse® ), or of Poly-L-lactic Acid (Sculptra® ). Nevertheless, hyaluronidase is incredibly effective when it comes to reversing the effects of hyaluronic acid fillers, particularly when it comes to lip enhancement or cheek augmentation.

How does Hyaluronidase work?

The treatment procedure involves the injection of a protein-based enzyme solution under the skin, which aims to break down the collection of hyaluronic acid, often the result of a previous cosmetic injection such as Restylane or Juvederm and other dermal filler treatments. Basically, it does the opposite of the filler itself, due to the enzyme.

The process for hyaluronidase injection treatment is simple and convenient. First, you’ll meet with Dr. Green to discuss your issues with your current hyaluronic acid filler results, as well as your medical history, and work together to develop a treatment plan that will best meet your needs. Then, for your hyaluronidase injection procedure, Dr. Green will administer hyaluronidase to the initial hyaluronic acid filler treatment area in order to reverse the effects. After your treatment, you can resume normal activity, as this procedure requires no downtime. For most patients, the appearance of the previous dermal filler will be completely reversed, though some may need a second or third hyaluronidase treatment.

In order to achieve the most accurate results for reversing the appearance of hyaluronic acid filler, it is best to wait a couple of weeks after your initial treatment to see how the dermal filler settles within the tissue. At this point, if you’re unhappy with your results, or if you witness rare side effects such as lumps under the surface of the skin, Dr. Green can provide hyaluronidase injections to restore your natural facial contouring.

What is Hyaluronidase used for?

The use of hyaluronidase injections is approved by the Food and Drug Administration (FDA) for a variety of treatments, and is commonly used for the following:

  • for fluid infusion through subcutaneous tissues (known as hypodermoclysis), particularly within pediatric care.
  • as an adjuvant to accelerate the diffusion of drugs and local anesthetics subcutaneously, in regards to both dispersion and delivery
  • as an adjunct in promoting absorption of contrast agents (dye) in urography (x-ray of blood or lymph vessels in the urinary tract)
  • as a method of edema reduction (off-label use)
  • as a treatment of vitreous hemorrhage
  • clinical use within chemotherapy patients for the treatment of extravasation (fluid leakage) in order to prevent tissue necrosis (skin cell injury).
  • for retrobulbar anesthesia within ophthalmic surgery
  • to dissolve the effects of hyaluronic acid fillers, particularly incited by allergic reaction, delayed-onset nodules, HA-incited blindness, Tyndall effect (blueish hue to the skin), vascular occlusion, or an unacceptable cosmetic outcome.

According to an in vitro study by Rao et al, hyaluronidase is successful in reversing the effects of most all popular hyaluronic acid fillers, though the amount of hyaluronidase needed to dissolve the fillers varied by formulation. The study looked at two hyaluronidase formulations and four  hyaluronic acid fillers that are commonly used in the United States and found hyaluronidase effective at reversing the effects of the fillers in each case. For additional clinical information on hyaluronidase there are many articles of note on Pubmed, in particular in the Journal of Cosmetic Dermatology and Dermatol Surg.

Does Hyaluronidase dissolve natural hyaluronic acid?

Hyaluronidase injections are excellent at dissolving hyaluronic acid, and this does mean that hyaluronidase is able to dissolve natural hyaluronic acid as well. However, hyaluronidase will target the hyaluronic acid linkage within the designated treatment area, which means that it will dissolve the hyaluronic acid filler before dissolving any natural hyaluronic acid. Additionally, hyaluronic acid is a substance that is both produced and dissolved by the body  constantly as a part of the body’s natural ebb and flow. Even if the hyaluronidase injection dissolved natural hyaluronic acid, your body will be able to restore your natural hyaluronic acid to its pre-filler level in very little time.

Dr. Green determines the appropriate amount of hyaluronidase for each injection depending on the dermal filler amount that was previously injected, and ensures that the amount of hyaluronidase is a safe and appropriate amount that reduces the risk of any and all side effects.

Does Hyaluronidase dissolve your own tissue?

Hyaluronidase does not dissolve your own tissue. Though Hyaluronidase can dissolve your body’s own natural hyaluronic acid, hyaluronidase is not able to dissolve tissue. Hyaluronidase, either naturally occurring within the body or as an injection, is able to break down hyaluronic acid and only hyaluronic acid, which means that it cannot break down normal tissues. Though occasionally  patients might observe a “depleted” appearance on their skin after hyaluronidase treatment, this is due entirely to the temporary absorption of hyaluronic acid. After a hyaluronidase injection, the skin will typically restore its hyaluronic acid levels within a few days or, in rare cases, over the course of a few weeks.

As hyaluronidase can dissolve natural stores of hyaluronic acid, it is incredibly important that a board-certified medical professional be relied upon to determine the amount of hyaluronidase necessary to reverse the effects of a hyaluronic acid filler. Dr. Green personally develops all hyaluronidase treatment plans and determines the correct amount for each patient. Her “less is more” approach is applied to both dermal filler and hyaluronidase treatment in order to optimize the effects of cosmetic injectable treatments and avoid any dissatisfaction. The safety and satisfaction of all her patients is Dr. Green’s top priority.

Can Hyaluronidase dissolve fat?

Hyaluronidase does not dissolve fat. Hyaluronidase is an effective way to dissolve hyaluronic acid, which is used in development of collagen fibers, and hyaluronidase injections are specifically used to dissolve hyaluronic acid filler injections. Fat cells are dissolved and metabolized within the body by different means, as fat cells are created through different processes in the body. However, fat cells can be metabolized through a variety of non-invasive cosmetic treatments offered by Dr. Green.

Fat cells can be dissolved by a different non-invasive injectable, Kybella. Kybella is an FDA-approved injectable that dissolves and contours submental fat, which can reduce pockets of fat, particularly for those frustrated by the appearance of a double chin or excess fat around the jawline. Kybella uses a synthetic form of deoxycholic acid, a natural substance that helps to metabolize dietary fat in the body. It’s able to eliminate fat cells near the injection site, thus preventing these fat cells from further fat accumulation. In this way, Kybella®  can actually permanently eliminate fat cells at or near the injection site. Kybella requires little to no downtime and often requires as little as one treatment for optimal results.

Another method of fat reduction that is highly popular is that of CoolSculpting® . CoolSculpting is an innovative body contouring device that uses “fat freezing” techniques (Cryolipolysis) to eliminate excess fat on the body. Though CoolSculpting is not a weight loss technology, it can be an ideal tool for those who have lingering pockets of fat in the abdomen, along the arms, or under the chin, even though they maintain a healthy lifestyle. CoolSculpting is able to “freeze” fat cells at a higher temperature than other cells in the body, and then these frozen cells are able to be metabolized naturally in the body. Over the course of several weeks, these fat cells will be permanently eliminated from the body. CoolSculpting is safe to use on a variety of areas on the body, including the legs, arms, stomach, lower back, upper back, bra area, and under the chin. The procedure requires no anesthesia, recovery or downtime, and the results are entirely permanent, provided patients don’t experience excessive weight fluctuation post-treatment.

How much Hyaluronidase is needed to dissolve filler?

The amount of hyaluronidase in a hyaluronidase injection varies widely depending on the current amount of hyaluronic acid filler in the treatment area, the type of hyaluronic acid filler, and the desired outcome of the hyaluronidase treatment. Particularly in the case of hyaluronic acid fillers that use cross-linking technology to delay its natural breakdown, more hyaluronidase may be needed. Additionally, whether the filler is particulate or non-particulate, and the concentration of hyaluronic acid within the formulation of the filler can affect the recommended amount of hyaluronidase.

Current literature widely diverges in terms of recommended hyaluronidase doses, so current recommendation is to rely on expert opinion and to use moderation in the application of hyaluronidase. Dr. Green tailors hyaluronidase treatment based on her expertise and extensive knowledge of hyaluronic acid fillers, and will follow-up with patients after an initial hyaluronidase treatment to determine whether a second (or third) hyaluronidase injection procedure is needed.

How long does it take for Hyaluronidase to work?

The effects of hyaluronidase will begin to appear immediately after a hyaluronidase treatment has taken place. However, the amount of time it will take for the full affect of hyaluronic acid filler reversal varies depending on the individual patient. The majority of patients see complete results from hyaluronidase injections over the course of a few days, though some may need two to three weeks in order to observe the full effects of the treatment.

After the hyaluronidase takes full effect, some patients may feel that they’d like to boost their collagen production through alternative means aside from dermal fillers. In this case, Dr. Green can help to develop a revitalizing skincare treatment plan, which can range from laser resurfacing to chemical peels to microneedling. Dr. Green is an expert in cosmetic dermatology and anti-aging techniques, and can help you to both look and feel like your best self.

Is Hyaluronidase safe?

Yes, like Juvederm and Restylane, it is safe to inject hyaluronidase, and side effects are rare. That said, you could potentially look at testing it gradually via multiple treatment sessions, which can be arranged with cosmetic dermatologist Dr. Green in New York.

Unlike procedures that use alternative substances such as Radiesse, Sculptra or silicone oil fillers, hyaluronic acid fillers can be re-shaped immediately after the procedure is done, or months later.

Does Hyaluronidase have any side effects?

Side effects to hyaluronidase are both rare and uncommon. The most likely side effect of hyaluronidase is mild allergic reaction near the injection site, with a reported incidence of between 0.05% to 0.69%. Recent studies have shown that hyaluronidase is antigenic, which means that repeated hyaluronidase injections of relatively large may lead to the production of neutralizing anti-bodies. This means that Hyaluronidase will not necessarily continue to be as effective in dissolving hyaluronic acid filler with large amounts of use. Additionally, it’s good to note that hyaluronidase should not be injected via intravenous injections, as this can put patients at risk for  allergic reactions and more severe side effects.

Occasionally, patients may observe a “depleted” look due to a temporary dip in the natural hyaluronic acid stores within the body. However, in this case, your natural hyaluronic acid will return to normal over the course of a few hours to a few days. If, after several weeks, your skin continues to appear depleted or sagging, Dr. Green can help to stimulate collagen production within the body to offset these undesirable effects. In this case, Dr. Green can work with you to develop a customized restorative treatment plan. Collagen stimulating treatments include laser resurfacing, Thermage, microneedling, and chemical peels, among others.

How is Hyaluronidase made?

Hyaluronidase is derived through the collection of natural hyaluronidase either via bovine sources or human albumin sources. In order to prepare a hyaluronidase injection, the hyaluronidase is combined diluted with saline or water. However, hyaluronidase is a highly complicated substance to create in injectable form, and should never be attempted to be made at home. Hyaluronidase should only ever be administered by a board-certified medical professional, and  only FDA-approved brands should be used. These include Hydase, Hylenex, Amphadase and Vitrase. Never under any circumstances should hyaluronidase be used from an unverified source. Dr. Green typically uses Vitrase’s hyaluronidase formulation for her hyaluronidase treatments, as she’s found its formulation to be reliable and consistent for a wide variety of patient needs.

What does Hyaluronidase cost?

The cost of hyaluronidase varies based on how much treatment is required and the areas affected. We can provide a quote based on consultation, but the average treatment ranges from $500 and up. When you work with Dr. Green, she will be sure to carefully assess your concerns due to hyaluronic acid filler, and provide you with a treatment plan that best fits your budget and individual needs.

Two treatments of Hyaluronidase under the eyes to dissolve improper juvederm injections under her eyes (tear troughs)

If you’re frustrated or disappointed in the effects for a hyaluronic acid dermal filler treatment, hyaluronidase injections may be the solution you’ve been searching for. Dr. Michele Green is a board certified dermatologist in NYC with over two decades of experience in cosmetic dermatology. Voted one of the best dermatologists in NYC, she will help dissolve your unwanted filler and can later inject you with hyaluronic acid filler with a cosmetically elegant result.

Find out more about hyaluronidase treatments to reverse unwanted dermal filler treatments by contacting Dr. Green online today or by calling 212 535 3088. Our offices are based in NYC, and we have patients from all over the world.

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