Hyaluronidase injection (filler dissolving)

What is hyaluronidase?

It is an enzyme, naturally present in the body, that cuts the long chains of hyaluronic acid. Injected into a filler, it breaks the gel down into small molecules that the body clears. It starts working within minutes and its action lasts 24 to 48 hours [6].

It also dissolves a little of the skin’s own hyaluronic acid, which the body rebuilds in less than a day, so there is no lasting effect on skin quality [6]. Controlled trials are few, but they confirm that it dissolves hyaluronic acid deposits, all the better when the dose is adjusted [7]. This use is described in international guidelines [1, 5, 6].

Who is it for?

Anyone who has had a hyaluronic acid filler, at the practice or elsewhere, and wants it corrected:

• an overdone or uneven result, such as lips that are too full;
• a small lump (nodule) you can feel or see under the skin;
• a bluish tinge under the eyes (Tyndall effect), when the gel sits too close to the surface, for example after tear trough filler;
• persistent swelling of the tear troughs or malar bags;
• filler that has migrated, for example above the lip;
• before a new injection, to start again from a filler-free area;
• some delayed inflammatory reactions, alongside medical treatment;
• as an emergency, a blood vessel blocked by the gel.

In a series of 114 patients treated with hyaluronidase, the reasons were overcorrection (45%), Tyndall effect (44%) and late nodules (11%); the eyelids were the area most often treated [9].

Which fillers can be dissolved?

• Cross-linked hyaluronic acid (lips, tear troughs, cheeks, temples, chin, jawline, nose): Yes; the densest gels sometimes need a second session
• Skin boosters, Profhilo: Yes
• Hyacorp (hyaluronic acid for the body): Yes
• Radiesse (calcium hydroxylapatite): No
• Sculptra (poly-L-lactic acid): No
• Silicone and permanent fillers: No

Hyaluronic acid gels do not all react to the enzyme in the same way: the more concentrated and cross-linked the gel, the more enzyme it takes [4, 6]. If you were injected elsewhere, bring the product name and the date of the injection if you can, for example the traceability card given after the session.

Emergency: a blocked blood vessel

Very rarely, the gel can block an artery during or after the injection. Signs appear within minutes or hours: unusual pain, skin that turns pale, then mottled or purplish, feels cold and is slow to regain its colour when pressed. Any change in vision is an absolute emergency: call 112 (15 in France).

Hyaluronidase is then injected without prior testing, at a high dose, throughout the area short of blood, and repeated every hour until the skin regains its colour [2, 3]. It is combined with cortisone and aspirin. The earlier the treatment, the better the outcome: in an analysis of 231 patients, treatment within 6 hours clearly improved recovery [8].

In Dr Médard de Chardon’s practice, no vascular emergency has occurred in more than 11,000 filler injections. If you notice these signs after an injection, call the practice at once on +33 (0)4 93 68 86 68.

How is the injection done?

1. ConsultationThe doctor examines the area and asks for the product name, the date and place of the injection, your allergies, especially to bee or wasp stings, and your medication. A skin test can be done if needed. Photos are taken.
2. Choosing the doseIt depends on the type and amount of gel, the area and what you want, to dissolve everything or only correct it. The doctor prefers small doses, repeated if needed, so as not to dissolve more than necessary [6].
3. InjectionWith a fine needle, directly into the gel, followed by massage to spread the enzyme. The session takes 15 minutes.
4. Follow-upAfter 1 to 2 weeks, with a second session if the result is not sufficient.

Tell the doctor about your medication: aspirin, anti-inflammatories, cortisone or antihistamines can reduce the enzyme’s effect and call for a higher dose [6].

Does the injection hurt?

You feel a burning or stinging sensation for a few seconds. A numbing cream can be applied before the session.

What is recovery like?

You can go back to your activities the same day. The swelling in the first hours comes from the injected fluid and the local reaction; it lasts from a few hours to 2 days. New hyaluronic acid filler is possible one week after the last hyaluronidase session.

What are the risks?

• Local reactions: redness, swelling, itching or a small bruise at the injection site, for a few days at most [6].
• Dissolving more than intended: the enzyme can remove part of the result you wanted to keep, which is why doses are given in small steps [6].
• Allergy: rare, about 1 case in 1,000 at the doses used in aesthetic medicine [6]. The risk is higher if you are allergic to bee or wasp stings [5, 6]. The practice keeps emergency allergy treatment on hand.
• Infection: the enzyme can help an existing infection spread, so a red, warm nodule is treated with antibiotics first [6].

Dr Médard de Chardon’s experience

Patients from Cannes, Antibes, Nice or elsewhere in the Alpes-Maritimes: for a hyaluronidase injection, Dr Médard de Chardon sees you at his practice at 101 rue d’Antibes in Cannes, with no hospital stay. Patients also travel from Paris, Lyon, Marseille, Bordeaux and Toulouse: Cannes is served by train and by Nice Côte d’Azur Airport.

How much does hyaluronidase cost in Cannes?

Frequently asked questions about hyaluronidase

References

1. King M, Convery C, Davies E. This month’s guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4). J Clin Aesthet Dermatol. 2018;11(6):E61-E68. PubMed 29942426
2. DeLorenzi C. New High Dose Pulsed Hyaluronidase Protocol for Hyaluronic Acid Filler Vascular Adverse Events. Aesthet Surg J. 2017;37(7):814-825. doi:10.1093/asj/sjw251
3. Cohen JL, Biesman BS, Dayan SH, et al. Treatment of Hyaluronic Acid Filler-Induced Impending Necrosis With Hyaluronidase: Consensus Recommendations. Aesthet Surg J. 2015;35(7):844-849. doi:10.1093/asj/sjv018
4. Landau M. Hyaluronidase Caveats in Treating Filler Complications. Dermatol Surg. 2015;41 Suppl 1:S347-S353. doi:10.1097/DSS.0000000000000555
5. Murray G, Convery C, Walker L, et al. Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol. J Clin Aesthet Dermatol. 2021;14(8):E69-E75. PubMed 34840662
6. Kroumpouzos G, Treacy P. Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations. JMIR Dermatol. 2024;7:e50403. doi:10.2196/50403
7. Borzabadi-Farahani A, Mosahebi A, Zargaran D. A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions. Aesthetic Plast Surg. 2024;48(6):1193-1209. doi:10.1007/s00266-022-03207-9
8. Alhusain AM, Alsaif M, Alkhathami AM, et al. Hyaluronidase Protocol in Management of Hyaluronic Acid Filler-Related Vascular Complications: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2026;50(6):2300-2317. doi:10.1007/s00266-025-05431-5
9. Bravo BSF, Bianco S, Bastos JT, et al. Hyaluronidase: What is your fear? J Cosmet Dermatol. 2021;20(10):3169-3172. doi:10.1111/jocd.14303