Hyalase

Hyalase - the easy answer in case you change your mind after Fillers

What can you do if you are unhappy with the results of your hyaluronic acid gel filler? Restylane and Restylane Perlane is very popular as a filler but sometimes there is an overfill…..

Oculoplastic and aesthetic surgeon, Jane Olver, of Clinica London, answers:

“I receive several such enquiries predominantly from patients across the country who want to have their treatments reversed – fortunately all of the Restylane and similar hyaluronic acid (HA) gel treatments are reversible with the injection of a product called Hyalase.

 “One of the biggest problems I am seeing is from patients who are still having the old fashioned technique of a big lake of Restylane injected into the tear troughs – it doesn’t look nice often producing a bluish/silvery tinge to the skin and it can shift around.

 “With the huge number of patients now having fillers it is not surprising that there will always be a small number who are not happy with their appearance. Perhaps it simply did not live up to their expectations, or it might have been injected in the wrong place with a bad technique. Possibly too much filler was used when a smaller quantity in conjunction with surgery might have produced a better result. I am a strong believer in doing less and producing a more subtle result”, said Jane.

“Sometimes the patient has had just a little bit too much put into the cheeks perhaps creating an asymmetrical appearance. This is a difficult situation for practitioners because in nature all faces have a degree of asymmetry. There is definitely an art to using Restylane on a face that might be asymmetrical – there is a fine line to making it symmetrical. It is a highly skilled art form and even in the best hands things can work out unexpectedly.”

Once injected into the correction site, the enzyme Hyalase quickly breaks down the hyaluronic acid gel causing most of the particles to gradually disappear. The remaining particles draw in water before also being absorbed.

The length of time for the effects of the Restylane-like product to last depends on the ‘heaviness’ of the HA gel, the quantity that has been used, as well as the position of the treatment. 

“I had a Hyalase patient who had been treated with a heavy Restylane which is now discontinued. It had been injected into her cheeks two years ago and it was still there and she wanted it reversed. Another reversal patient was a younger woman who was not happy with a Restylane treatment for her lower face”, said Jane.

Hyalase comes in 1 mil vials and it is used in quantities dependent on how much HA gel needs to be melted away. Before reversal treatment, it is mixed with a saline solution so that it doesn’t hurt. Jane then injects where she can palpate or see the excess Restylane. It will work within hours and the next morning the patient can expect to feel a little bit deflated where it has been injected.

Research shows that the enzyme Hyalase has no effect on the patient’s own hyaluronic acid which forms the crucial role of binding water, hydrating the skin and promoting softness and fullness.

“There is no direct scientific equation indicating the exact quantity of Hyalase to use – it is a matter of judgement and experience. Most often patients expect to have more filler afterwards– injected with the correct quantities and technique. Very occasionally a patient might be thrilled to see the return of her eye bags – but that is rather rare!”

Risks with Hyalase are minimal however a very small number of people might be allergic to the enzyme. “Just to be on the safe side I make sure that my patients are covered with a prescription of Puritan and a small quantity of a steroid ... just in case”, said Jane.

Hyalase is not a new product having been known to the ophthalmic world for more than 30 years. It was originally used in cataract surgery in the 1980's.