this hyaluronidase also dissolve natural hyaluronic acid I see a lot of people
who come in dissatisfied with hyaluronic acid filler placement performed by other
practitioners including both physicians and non-physicians I'm often told that
the patient had received several hyaluronidase injections and that they
still didn't look better they report that the practitioner was intentionally
being conservative when dissolving the hyaluronic acid filler in order to avoid
having the patient look worse because of the hyaluronidase potentially affecting
the naturally occurring hyaluronic acids in the body I'll discuss how I use
hyaluronidase in my practice to help people who come in with problems after a
hyaluronic acid filler placement I'm Dr. Amiya Prasad I'm a
Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I've been in practice in Manhattan and Long Island
for over 20 years I use hyaluronic acid fillers extensively in my practice I use
these fillers to enhance the volume of the lips cheeks chin jawline and to
treat hollowing under the eyes I also treat lines acne scars and wrinkles
throughout the face I regularly use hyaluronic acid with platelet-rich
plasma to improve skin quality in the face neck and decollete with a procedure
called skin boosting I also see a lot of people who come in after being treated
elsewhere and who need their hyaluronic acid filler dissolved as soon as
possible so I use a lot of hyaluronidase in my practice this concern about the
potential loss of natural hyaluronic acid in the body can be put into
perspective when you understand where your natural hyaluronic acid
actually exists further if there is an indication for needing hyaluronidase
it's usually for a situation which needs urgent and definitive action I see a lot
of patients who had hyaluronic acid filler placed under the eyes and cheeks
which needs to be dissolved this can be an indication that the filler is present
just below the skin the muscle and even the space behind the structure called
the orbital septum the space behind the septum is where the under-eye fat
pockets are and is referred to as the orbit this is also the same anatomic
space occupied by the eye I often see placement of filler to camouflage under
eye bags actually caused the under eye bags to appear even larger all these
levels of tissue where the hyaluronic acid has ended up requires in my opinion
experience and familiarity with this anatomy that a surgeon like myself is
comfortable with in fact long before the hyaluronic acid
fillers were introduced hyaluronidase was used in ophthalmology for the
purpose of improving the absorption of local anesthetic behind the eye before
eye surgery or cataract surgery I routinely performed displacement of
anesthetic with hyaluronidase before cataract surgery using blunt needles
this technique is called retrobulbar injection needless to say this required
a very good understanding of the anatomy of the delicate structures in a very
small space where the optic nerve and other important eye structures exist
since I perform a lot of eyelid surgery the spaces around the eyes are very
familiar to me I work with precision when placing hyaluronidase for the
purpose of dissolving the hyaluronic acid filler with consistent success I
have found that being a surgeon has been very useful in both placement of
hyaluronic acid filler as well as the dissolving of the hyaluronic
acid with hyaluronidase it all comes down to the level of experience with
this anatomy so when looking at a situation of problematic filler
placement we have the conceptual issue of native hyaluronic acid loss and the
pressing situation of an unhappy individual who often takes days off work
because they don't like the way they look I addressed this often emotionally
charged issue by performing conservative and precise placement of hyaluronidase
these patients are relieved and generally happy with their outcome
without any complaint about their appearance as a result of the
hyaluronidase treatment in conclusion although hyaluronic acid native to the
area that needs to be treated may be affected in my clinical experience this
is less important than dissolving the hyaluronic acid responsible for an
undesirable outcome I hope you found this information helpful thank you for
your question
you