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Enzyme — Hyaluronic Acid Filler Reversal Agent Pregnancy: Avoid elective use in pregnancy — safe for emergency vascular occlusion treatment

Hyaluronidase

Brand names: Hyalase

Adult dose

Dose: Filler dissolution: 150–1500 units injected into affected area; vascular occlusion emergency: 500–1500 units immediately
Route: Intradermal / Subcutaneous / Intra-arterial territory injection
Frequency: Repeat every 30–60 min until resolution in vascular occlusion
Max: No upper limit in vascular occlusion emergency — use as much as needed
Dissolves hyaluronic acid (HA) fillers. Emergency use: vascular occlusion (skin blanching, pain, dusky discolouration after filler) — inject hyaluronidase immediately without delay. Also used to facilitate fluid absorption (SC fluids) and to increase local anaesthetic spread.

Paediatric dose

Route:
Seek specialist opinion. Used for SC fluid facilitation in paediatrics: 150 units injected SC before fluid administration.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No adjustment required.

Clinical pearls

  • Vascular occlusion from HA filler is a TIME-CRITICAL emergency — vision loss from ophthalmic artery occlusion can occur within 90 minutes. Inject hyaluronidase immediately without waiting for imaging confirmation.
  • British College of Aesthetic Medicine (BCAM) emergency protocol: 500 units into the area of occlusion, massage vigorously, reassess at 30 min — repeat until blood flow restored
  • Allergy skin test: 3 units intradermally — observe 15 min for wheal/flare before elective use

Contraindications

  • Hypersensitivity to hyaluronidase or bee/wasp venom (rare cross-allergy)
  • Infected areas (relative — spread of infection risk)
  • Do NOT inject into blood vessels directly

Side effects

  • Local swelling and bruising at injection site
  • Anaphylaxis (rare — skin test recommended before elective use)
  • Over-dissolution of natural HA (temporary facial volume loss)
  • Spread of local anaesthetic beyond intended area

Interactions

  • Local anaesthetics (increases spread and absorption — reduce LA dose to avoid systemic toxicity)
  • Furosemide/benzodiazepines/phenytoin (incompatible — do not mix for SC infusion)

Monitoring

  • Skin colour and capillary refill (vascular occlusion)
  • Visual acuity (if periorbital/forehead filler — ophthalmic artery territory)
  • Repeat assessment every 30 min during treatment

Reference: BNFc; BNF 90; BCAM Filler Emergency Guidelines 2022; JCCP (Joint Council for Cosmetic Practitioners) Vascular Occlusion Protocol. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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