Does hyaluronidase remove all the filler? Sagging and risks

Hyaluronidase can remove all of a hyaluronic acid filler, or only part of it, depending on the goal and the professional's technique. It does not act on other materials, such as PMMA or collagen biostimulators. Nor does it cause sagging by itself: what can appear is the lack of support that the volume was hiding. And, because it is a protein, it carries an allergy risk, which must be considered beforehand.

This page answers the three questions patients usually ask when the enzyme is suggested: "will it all go?", "will I end up saggy?" and "is it dangerous?". The time it takes to work and the swelling in the following days are covered in hyaluronidase: how long it takes to work.

Does hyaluronidase remove everything at once?

Not always, and not always what is wanted. Some factors explain why the result varies:

In practice, it is common to work in stages: inject, wait for the area to stabilize, reassess and decide whether more is needed. Locating the product is sometimes done with imaging, such as ultrasound, at the professional's discretion.

Can hyaluronidase cause sagging?

The enzyme does not "melt" skin or collagen. The feeling of sagging afterward usually has three explanations:

1. The concern already existed. The volume was supporting or masking a loss of structure. Without it, the face shows how it was before, plus the time that has passed since the filler.
2. The skin was stretched. In cases of large volume for a long time, the skin may have adapted to the larger space and take a while to readjust.
3. Transient effect on natural hyaluronic acid. The enzyme may break down some of the area's own hyaluronic acid. The body continuously replaces it, and this effect is usually temporary.

Showing photos from before the first filler, when they exist, helps a lot: the patient sees that they are not "worse than before", but simply without the product.

What are the risks of hyaluronidase?

Like any injection, it can cause pain, redness, swelling and bruising at the site. The risks that need special attention are:

Can hyaluronidase cause an allergy?

It can. Hyaluronidase is a protein, and the body may react to it. The most cited reaction is local, but broader reactions are described. Some points usually weigh in the assessment:

• history of allergies, mainly to bee or wasp stings, whose venom contains hyaluronidase;
• previous reactions to the enzyme itself;
• use of medications and conditions that alter the immune response.

Whether and how to do a prior test is the professional's decision and is debated in the literature; the discussion is in hyaluronidase: allergy and testing. In any case, the clinic must be prepared to recognize and treat a reaction.

Is hyaluronidase registered with ANVISA?

There are industrialized and compounded presentations, with different rules. Before using it, check the registration and the origin of the product. What the regulation says and how to buy safely is in hyaluronidase and ANVISA. ANVISA is Brazil's health regulatory agency.

When does it make sense to use the enzyme?

The most common indications are:

• excess volume or an artificial result, the subject of overdone facial harmonization;
• bluish tone from superficial product;
• hyaluronic acid nodules;
• product that has shifted, the topic of hyaluronic acid migration;
• suspected vascular occlusion, as an emergency.

In every case, explain the goal, the risks and the stages, and record the informed consent. The document can start from the hyaluronidase consent form template.

In Harmy, if the patient decides to replace volume after the correction, the new projection with the revised ml helps agree on a more discreet goal. It is an illustrative simulation, made from the current photo.