Hyaluronidase for correcting hyaluronic acid injections

As a specialist of eyelid and under-eye circle surgery, I notice an ever-growing number of complications from hyaluronic acid injections used in circles.

This is, actually, a technique that returns excellent results and is becoming widely popular, it is ever-more frequently performed doctors who are inexperienced in this technique and not at ease in performing injections in the peri-ocular zone and in under-eye circles in particular.

Generally-speaking, they inject too much of the product and too superficially; the hyaluronic acid, therefore, behaves like a sort of swollen sponge and forms a sort of pouch which, in addition, takes on a bluish aspect as a result of the diffraction of light on a transparent gel.

These patients consult for “bags”/pouches under the eyes, they have generally forgotten the under-eye circles injection episode which may have taken place a few years beforehand and are extremely surprised, because they believe, and rightly so, that the hyaluronic acid had been absorbed

But, as it turns out, hyaluronic acid is not absorbed under the eye or, if it is, it can take several years to do so (I have seen patients with a pouch of hyaluronic acid that had been injected over five years before).

The very positive side, however, is that an antidote for hyaluronic acid exists today: hyaluronidase which dissolves all the acid injected.

This is a revolution for aesthetical medicine as it is the first time ever that a product that has just been injected can be dissolved (it is like having a pencil and a rubber).

Procedure:

As is always the case in this profession, it is necessary to have some experience before injecting hyaluronidase.

• First of all, an allergy test must be performed prior to the injection (a prick test on the forearm 24 hours before the injection), to eliminate patients who are allergic to hyaluronidase (very rare cases).
• Inject very small doses of hyaluronidase so that the hyaluronic acid is not removed from the dermis, then continue in further than before the injection of the under-eye circle.

Conclusion :

JI have noticed that there are an ever-growing number of consultations for pouches that end up being hyaluronidase injections, these are false, iatrogenic pouches, created by hyaluronic acid injections that were too superficial and overdosed.

To avoid this complication, and I have said this over and over again, hyaluronic acid must be injected into the under-eye circle at bone-contact level to be sure that you are under the orbicularis muscle and very, very fine needles must be used (32 gauge). Injection flow rate is, therefore, very low and prevents you from injecting too much of the product, you must always remember that hyaluronic acid behaves like a sponge and swells after the injection.

This is why I always perform my under-eye circle injections in 2 goes, with a 3-week gap between the 2 to be sure I do not inject too much of the product.