Let’s talk about Hyalase with Dr Holmes

Let’s talk about Hyalase with Dr Holmes

Will Hyalase dissolve my face?
Ok, I’m sure some of you are thinking, what is Hyalase anyway? Well, if you get dermal fillers, you need to know what this is because you are likely to need it sometime.
Hyalase, or hyaluronidase, is an enzyme that breaks down hyaluronic acids. The most commonly used dermal fillers are made of hyaluronic acids AND we have our own in our skin for hydration and plumping.
The most common uses in cosmetic medicine for this drug is to dissolve filler in the result of a vascular occlusion event/emergency. Our face is full of blood vessels. The reality is that as injectors we are going in and out of tiny vessels in the face most of the time. Therefore, it is important to inject gently, with small volumes, and keep the needle constantly moving, so if any gets in a vessel it is only a small amount. If filler blocks off a vessel, this needs to be dissolved as soon as possible to avoid permanent tissue damage. This event happened in our clinic today. I have only treated one other case like this in my 20 years of practice, but it is inevitable. As a patient, you want to be somewhere where there is immediate access to this dissolver and medical care. I’d suggest you also only want to have filler used in your treatments, that can be dissolved. If you have this complication with a filler that isn’t a hyaluronic filler, you are stuck with the blockage, and it is a very bad thing.
Overfilling with dermal fillers is a pandemic at the moment in the world. This is driven by patient demand for unrealistic outcomes, uneducated injectors, or unethical injectors. I have sent away patients and not treated them if they are asking for more fillers but don’t need them or would look unnatural as a result. Hyalase is being used to remove this excess filler. There is a push by experts to use less and less fillers and embrace treatments that result in natural appearance and healthy skin, like PRP, BBL, Tixel, lasers, active skincare and so on. Some injectors are talking about dissolving all a patient’s fillers every 5 years and starting again to avoid this over filling from persisting fillers and too much in the first place.
In some circles, patients and injectors who may be overfilled themselves, are losing perspective on what “normal” is. It is not normal for your cheek curve to finish under your borrow lashes for example. This is now called a “perceptual drift”. Research has shown that there is a significantly higher number of cosmetic injectors that have Body Dysmorphic Syndrome than in the general population. (And there’s a worry and part of the problem). Have you ever seen a clinic where the injector and all the patients look the same? Sad but true.
Hyalase is also use for sculpting filler or correcting areas where fillers have migrated into a lump or bump, or where a patient has had a hypersensitivity reaction to them.
So, when you inject Hyalase (which has been used for 80 years, at first in ophthalmology), does it selectively dissolve the dermal filler and not our own natural hyaluronic acid? No, of course not. BUT research has shown that in 48 hours we regenerate any of our own that has been affected. There is likely to be a period of a day or two where a person feels deflated and less springy, or more wrinkly in a treated area. But within the week this corrects.
Hyalase dissipates from the area very quickly, which is why in a vascular event, we will inject the area over and over. You may have read social media posts like “ Hyalase destroyed my face”. Evidence is really against this possibility. If Hyalase could permanently dissolved the subcutaneous fat we’d be injecting lots of other body areas – 6 pack anyone? In medicine, you never want to say something will NEVER happen though, but you’d have to say it seems to be an incredibly rare event that someone’s hyaluronic acid takes years to rebuild because of some problem with their cell function.
So, if you don’t want to have to ever deal with Hyalase injections, you really need to choose not to have dermal fillers at all, as the odds are, you will need it sometime.