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A. John Vartanian, MD; Andrew S. Frankel, MD; Mark G. Rubin, MD

Arch Facial Plast Surg. 2005;7:231-237.

Objective  To determine the effects of injected hyaluronidase in cutaneous areas previously augmented with Restylane (Q-Med AB, Uppsala, Sweden), a nonanimal, stabilized hyaluronic acid (NASHA) gel.

Methods  A prospective, randomized study was undertaken in 2 parts. First, the effects of hyaluronidase and saline were compared on post-NASHA dermal augmentation. Next, 3 different doses of hyaluronidase were evaluated after NASHA gel dermal augmentation. A blinded evaluator assigned postinjection skin scores. Each patient served as his or her own control.

Results  Hyaluronidase dramatically reduced the size of the augmentation created by injected Restylane in all of our subjects. A comparison of average scores of saline-injected sites vs hyaluronidase-injected sites revealed a statistically significant difference. By 4 to 7 days after hyaluronidase injection, skin scores were at 20% of baseline (P<.001). Dose-related response to injected hyaluronidase was also observed, although it was not statistically significant. A number of patients (25%) demonstrated localized, self-limiting hypersensitivity reactions to injected hyaluronidase.

Conclusions  Intradermal hyaluronidase injections can be used to reduce dermal augmentation from previously injected Restylane. A small dose of hyaluronidase equivalent to 5 to 10 U may be injected initially.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles (Dr Vartanian); Department of Surgery, Division of Head and Neck Surgery, University of California, Los Angeles, UCLA School of Medicine (Drs Vartanian and Frankel); and Lasky Clinic (Dr Frankel) and Lasky Skin Clinic (Dr Rubin), Beverly Hills, Calif.

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