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  • Low-Dose Hyaluronidase for Reduction of HA Nodules

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
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    Journal Highlights

    JAMA Dermatology
    2018;154(7):765-772

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    In the first randomized study to eval­uate the issue, Alam et al. tested the effectiveness of low-dose hyaluronidase to reduce aliquots of hyaluronic acid (HA) filler that had been injected into patients’ arms. They found that very small doses permitted dissolution of minute quantities of HA filler and eliminated the need to remove the en­tire implant. This indicates a potential role for low-dose hyaluronidase in resolving minor asymmetries that may occur with such fillers, as can occur with injections in the periorbital area.

    This study was a split-arm, paral­lel-group randomized trial of 72 injec­tion sites among 9 women (mean age, 45.8 years). Aliquots of Juvéderm Ultra XC (Allergan) or Restylane-L (Galder­ma) were injected bilaterally into the upper inner arms of each participant. At 1, 2, and 3 weeks following the injections, each injection site received a constant volume (0.1 mL) of vari­able-dose hyaluronidase (1.5, 3.0, or 9.0 U per 0.1 mL) or saline control.

    At both the 4-week and 4-month marks, physician assessments of filler detectability were significantly different for saline and hyaluronidase. Findings were similar for subjects’ self-assess­ments. The areas that received 9.0 U of hyaluronidase were significantly less palpable than those that received 1.5 U. Dose dependence was more common with Restylane-L.

    Although very small doses of hyaluronidase can disintegrate HA, slightly higher doses usually provide faster dis­solution. Low doses may be effective if only subtle changes are needed, such as refining contour. The low-dose strategy may be more appropriate, convenient, and satisfying for certain patients.

    The original article can be found here.