Transarterial degradation of hyaluronic acid filler by hyaluronidase

Dermatol Surg. 2014 Aug;40(8):832-41. doi: 10.1097/DSS.0000000000000062.


Background: Hyaluronidase (HYAL) has been recommended in the emergency treatment of ischemia caused by accidental intra-arterial injection of hyaluronic acid (HA) dermal fillers. To date, there have been no published studies showing that HYAL can pass through intact arterial wall to hydrolyze HA emboli.

Objective: The goal of this study was to study whether or not HYAL could cross intact human facial arterial wall to hydrolyze HA filler.

Materials and methods: Short tied-off segments of fresh human cadaver-sourced facial artery specimens, overfilled with a monophasic dermal filler (dermal filler "sausages"), were immersed in either HYAL or normal saline as controls. At 4 and 24 hours, the vessels were removed from the preparations, and one end of each vessel was cut open.

Results: Only the HYAL-immersed specimens showed degradation of filler gel.

Conclusion: In conclusion, cross-linked HA is susceptible to hydrolysis by HYAL when contained within the intact facial artery in a cadaver model, indicating that direct intra-arterial injection of HYAL is likely not necessary to help restore the circulation of ischemic tissues. This bench study provides support for the current recommended treatment of accidental intra-arterial injection with HYAL injection diffusely into ischemic tissues.

MeSH terms

  • Arteries
  • Cadaver
  • Capillary Permeability*
  • Dermatologic Agents / chemistry
  • Dermatologic Agents / pharmacokinetics*
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / chemistry*
  • Hyaluronoglucosaminidase / chemistry
  • Hyaluronoglucosaminidase / pharmacokinetics*
  • Hydrolysis
  • Medication Errors


  • Dermatologic Agents
  • Hyaluronic Acid
  • Hyaluronoglucosaminidase