Hyaluronidase to correct hyaluronic acid injections

These patients come to see me for bags under the eyes. They have generally forgotten about an injection into the dark circles that may have taken place several years earlier, and they are very surprised, since they rightly assume that the hyaluronic acid has been resorbed.
It turns out, however, that under the eye hyaluronic acid is either not resorbed at all, or takes several years to be resorbed. I have seen patients with a pocket of hyaluronic acid injected more than five years earlier.

The good news is that there is now an antidote to hyaluronic acid: hyaluronidase, which dissolves all the acid injected.

This is a notable advance in aesthetic medicine, as it is the first time we have been able to dissolve a product that has just been injected. We now have both a pencil and a real eraser.

Technique of the procedure:

As always in this profession, a certain amount of experience is needed to inject hyaluronidase.

• An allergy test must be carried out beforehand, a prick test on the forearm 24 hours before the injection, in order to rule out patients allergic to hyaluronidase. Such cases are very rare.
• Very small doses of hyaluronidase are injected, so as not to remove the hyaluronic acid naturally present in the dermis and hollow out the area even more than before the injection into the dark circle.

Conclusion:

I am seeing more and more consultations for bags that turn into hyaluronidase injections. These are false, iatrogenic bags, created by hyaluronic acid injections that were too superficial and in too large a quantity.

To avoid this complication, I have always stressed the need to inject the hyaluronic acid on bone contact, to make sure it lies under the orbicularis muscle, and to use very fine needles (32 gauge). The injection rate is therefore very low, which prevents too large a quantity of product being injected, and it must always be borne in mind that hyaluronic acid behaves like a sponge and swells after injection.

That is why I always carry out my injections into the dark circles in 2 stages, 3 weeks apart, to be sure that I do not inject too much product.