Hyaluronidase – The “Magic Eraser” for Hyaluronic Acid (Juvederm, Restylane) Dermal Fillers

Hyaluronic Acid dermal fillers are the most popular fillers used worldwide.  In the United States, the commonly used HA fillers are:

  1. Juvederm Ultra and Ultra Plus
  2. Voluma
  3. Restylane
  4. Restylane Lyft (Perlane)
  5. Restylane Silk
  6. Belotero

The beauty of HA fillers is that they are very well tolerated because hyaluronic acid is a component of skin, so it is a naturally occurring substance.  It’s a soft product, and will last anywhere from 4 months, to up to 2 years, depending on the brand used, and the location it is placed.

Another key attribute to the HA fillers popularity is that it can be completely dissolved with an enzyme called hyaluronidase.  It is manufactured from either bovine (cow) or ovine (sheep), so there is a remote possibility of having an allergic reaction to the commercially available products (Vitrase, Hydase, and Amphadase).  There seems to be a crossover with people that are allergic to bees for these animal derived products.  Hylenex is a recombinant form of hyaluronidase that is the human form that is the preferred form of Dr. Weiner for there are no allergies, yet it is a bit more expensive.

Hyaluronidase is useful for dissolving HA filler in the following instances:

  1. The filler was over done/”over filled” and it is not aesthetically pleasing
  2. There is prolonged swelling, particularly around the eye and most often with Juvederm
  3. An infection has occurred in the area of prior filler
  4. The filler is lumpy or has nodules and doesn’t respond to massage and time (especially lips)
  5. Rare possible allergic reaction to the HA filler
  6. When there is vascular compromise secondary to the HA filler injection which can be caused by external compression on a vessel or intraluminal (within the vessel) injection

My experience with hyaluronidase has been mostly with patients that have had Juvederm injected in the tear trough area from another facility.  I strongly recommend that Juvederm not be injected in this area because of the risk of prolonged edema.  The reason this happens more with Juvederm is speculated to be due to its ability to attract more water, higher concentration of HA in the product, and because it spreads more diffusely than the other fillers.

When injecting emergently for vascular compromise, at least 200 units (more is better) should be injected in and around the original site of injection of the HA. It has been shown that extravascular hyaluronidase is able to traverse the vessel wall to make it intraluminal, useful knowledge for the cases where the HA is within the vessel. (Blindness needs emergent Ophthalmology evaluation and might require arteriogram for placement of hyaluronidase. Even with such extraordinary measures, blindness is almost always permanent.)

When injecting hyaluronidase, it is mixed with lidocaine by the physician, so it is a fairly comfortable procedure.  There are a couple limiting factors with the injection.  It is not as precise as the filler injection, so it can remove some of the filler that you wanted to stay along with the unwanted filler.  Also, dosing/how much to use, is not an exact science.  It may take more than one treatment to dissolve the HA filler.  The results can occur within minutes, but usually take about a day to fully appreciate.  Also, Juvederm and Voluma tend to be the hardest to dissolve, and it is thought that this is related to the way it is cross linked (manufacturing process).

The bottom line is that you don’t have to live with HA filler that you are not happy with.  You can easily reverse lips that are lumpy or too big, swelling around the eye from filler, or dissolve an over correction or asymmetry with hyaluronidase.  An injection with hyaluronidase can get you back to where you used to be in about 24 hours.  Also, it’s nice to have a little piece of mind when getting injected with an HA filler that the process can be completely reversed with a small procedure.

Dr. Steve Weiner is a Facial Plastic Surgeon who “laid down his scalpel” in 2005 and concentrates solely on non invasive and minimally invasive cosmetic procedures at The Aesthetic Clinique.   His website is http://www.theclinique.net .  Call for a consultation:  850.622.1214

Blog: https://stevenfweinermd.wordpress.com/

YouTube: http://www.youtube.com/user/StevenFWeinerFacial


  1. julie

    Hi please could you help I had uma junesse put in one side of my face for the lines. It spread up my face towards my eyesocket I have just recently felt tiny beads top of my cheek bone under eye socket and one larger lump on my eye. Where can I get these dissolved please.

    • I’m not familiar with this but after researching, it is a hyaluronic acid and should respond to hyaluronidase.

    • This is a hyaluronic acid and should be dissolved with hyaluronidase.

  2. nelly

    Hy i have teosyal redisinty 2 for eyes on 25 january and than to touch up on 2 april and than begin the problems with swelling etc. so i have hylase on 11 july 2014 one treatment. it goes raplidly down. my question is how long it takes the naturel hyluronic acid comes back and the skin rehabes. it is 2 months ago, it looks a little bit better but not so like before the treatment with the filler.
    I’m 27 years old and i’m from switzerland please can you answering me. sorry for my bad english.

    • I should go back to where it was before you had filler very quickly. If it’s not, go see your doctor again.

  3. Quite nice and productive article shared on Dermal Fillers, must be compulsorily read by all prospective skin treatment aspirants

  4. Julia

    I had juvaderm or restylane (not sure which one) injected into my nasiolabal folds 9 months ago. I had quite a lot of swelling the week after which was very stressful as I looked like the joker. The swelling eventually went down but I am unhappy with the result. I decided to wait a few months and hope the puffiness would go away but it hasn’t. The problem is the product seems to have gone above the nasio labal lines to the side into my cheek. My smile is not as wide as before and when I smile my cheeks are very puffy like a chipmunk . I’m terrified to go back for Hyaluronidase in case I look worse than now or have a reaction to it. I have had this filler in the nasiolabal folds at Least 3 times before and been happy with the result. This is causing me a lot of anxiety. Could you please advise me
    Thank you

    • Go with hyaluronidase, nothing to be concerned about. Very easy.

  5. adam

    there is a lot of suggestions online that hyalurodinase degrades the skins natural occuring tissue, which is i think what Nelly from Switzerland in the comments above was suggesting had happened to her. What do you make of it? is using hyalurodinase a risk?

    • In theory, this can occur. In patients, it doesn’t seem to occur. Many docs routinely use hyaluronidase when injecting local and there are no adverse side effects. The thing to remember is that our bodies are dynamic and the hyaluronic acid is always being replenished.

  6. Sophie

    Dear Steven, I hope you can help me. I’ve had an HA-filler injected in the tear through and under my eyes (and also in other places as this was a liquid facelift). After three months I started feeling a hard mass under my eye which was followed the next day by an extreme swelling. The swelling lasted a few days and then disappeared, however, it reappeared after a few days under the other eye. This has now gone on for two months despite multiple injections of hyaluronidase and weeks of Prednisonol. Nothing seems to be helping and I’m feeling really desperate. Do you have any suggestions for further treatment? Thanks in advance. Kind regards, Sophie van Reeden, Amsterdam, the Netherlands

    • Try 5FU and Kenalog injection.

    • Should be treated as a granuloma.

      • Sophie

        Thanks so much for your reply. I will pass it on to my doctor.

  7. Sophie

    Hi Steven, I have two more questions:
    1. Is it the granuloma that is causing the swelling?
    2. Why is it not responding to the hyaluronidase?
    Thanks so much.
    Best, Sophie

  8. Granulomas don’t respond to hyaluronidase, it’s an inflammatory problem. Yes, it is causing it.

    • Sophie

      Thanks again!


  1. Amazing Things That Can Be Done (By the Experts) With Dermal Fillers | stevenfweinermd
  2. Why Juvederm is NOT a good choice for the Tear Trough or Eye Area | stevenfweinermd
  3. What is Vascular Occlusion or Vascular Compromise from Dermal Fillers? | stevenfweinermd
  4. Commonly Asked Questions About Lip Filler Problems | stevenfweinermd

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