Survey Shows Variability in Hyaluronidase Use Among Practitioners

New research suggests there are inconsistencies in the use of hyaluronidase (HYAL) for the treatment of adverse events with hyaluronic acid (HA) fillers, suggesting a need for standardized guidelines.

"With the growing popularity and administration of HA fillers, there is likely to be a concomitant growth in filler-related complications and the utilization of HYAL in its role of dissolving HA fillers," the authors wrote in Aesthetic Surgery Journal. "Filler-related complications involve unaesthetic results or reactions to the filler such as hypersensitivity, infection, nodule formation, or vascular adverse events."

Researchers surveyed 264 healthcare practitioners (244 from interrogated databases and 20 from a consensus panel) to understand current practices and attitudes towards HYAL use. Answers were compared to those of the consensus panel. The survey instrument consisted of 39 questions.

The results showed significant differences between the database group and the consensus panel. The consensus group displayed greater confidence in preparing HYAL, stored reconstituted HYAL for longer periods, and were less likely to perform skin tests for HYAL sensitivity. The consensus panel was also more inclined to use HYAL in emergencies, even in patients with a history of anaphylactic reactions to wasp or bee stings. According to the findings, 92% of all respondents had never observed an acute reaction to HYAL (1% reported encountering anaphylaxis). Additionally, 74% of practitioners consistently obtained patient consent for potential HYAL use when injecting HA. Long-term adverse effects included deep tissue loss.

"Hyaluronidase would appear to be an essential agent for anyone injecting HA filler," the authors wrote. "However, there is an absence of evidence-based recommendations with respect to the concentration, dosing, and treatment intervals of HYAL, and these should ideally be available."

Source: Currie E, et al. Aestheic Surgery Journal. 2024;44(6):647-657. Doi:10.1093/asj/sjae009