Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol

J Clin Aesthet Dermatol. 2021 Aug;14(8):E69-E75. Epub 2021 Aug 1.


Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for the patient. Hyaluronidase is an enzyme that was first used in general medicine in 1949, but has gained widespread use in aesthetic medicine to dissolve hyaluronic acid (HA)-based dermal fillers. Knowledge of this drug and its use for other aesthetic indications is evolving, and there is often anxiety attached to the administration of animal-derived product due to fears of an allergic reaction. This paper provides guidance on the indications for use when dissolving HA filler with hyaluronidase. It discusses formulation differences, adverse events, allergy to wasp and bee stings, and how this increases risk of allergy to hyaluronidase. It also discusses incidence of allergy, which includes a discussion of types of allergic response and how this correlates to skin tests and a discussion on skin testing for allergy.

Keywords: DON; Hyaluronidase; cross-linked hyaluronic acid; delayed inflammatory reaction; delayed-onset nodule; dermal filler; elective dissolution; high-dose protocol; hyaluronic acid; hylenex; vascular occlusion.

Publication types

  • Review