USC Roski Eye Institute, Keck School of Medicine, 1450 San Pablo St., 4th Floor, Los Angeles, CA 90033, United States.
USC Roski Eye Institute, Keck School of Medicine, 1450 San Pablo St., 4th Floor, Los Angeles, CA 90033, United States.
J Plast Reconstr Aesthet Surg. 2021 Apr;74(4):881-889. doi: 10.1016/j.bjps.2020.10.051. Epub 2020 Nov 6.
Hyaluronic acid (HA) fillers can be reversed with hyaluronidase, but their dose responses are not well-characterized. We evaluated 12 fillers' in vitro responses to varying doses of recombinant human hyaluronidase (RHH).
For the 12 HA gels, 0.2 mL aliquots were placed on six slides. Samples received no injection, saline injection, or RHH (2.5, 5, 10, or 20 units). The most resistant gels received 40 units of RHH on a seventh slide. Photos of gels were taken from bird's-eye and lateral views with a ruler at multiple time points.
Restylane-L and Restylane Lyft were the most easily dissolvable HA fillers. Both demonstrated a significant response to 2.5 units RHH/0.2 mL. Juvéderm Ultra, Belotero, Restylane Silk, and Restylane Defyne had moderate resistance to RHH. Restylane Refyne, Juvéderm Ultra Plus, Vollure, Versa, and Voluma were most resistant, requiring more than 20 units RHH/0.2 mL for complete dissolution. Volbella was moderately resistant up to 20 units RHH but demonstrated pronounced dissolution with 40 units RHH.
This study visually and objectively demonstrates the in vitro response of HA to dissolution by hyaluronidase. Fillers were categorized into least, moderate, and most resistant to RHH. Interesting findings include markedly different degrees of liquefaction for products used for similar indications (such as Restylane Lyft being more liquefied than Voluma), and Belotero easily flattening but retaining texture. Combined with in vivo data, this may help calculate hyaluronidase doses needed for controlled, partial reversal of commercially available HA gels.
透明质酸 (HA) 填充剂可用透明质酸酶逆转，但它们的剂量反应尚未得到很好的描述。我们评估了 12 种填充剂对不同剂量重组人透明质酸酶 (RHH) 的体外反应。
对于 12 种 HA 凝胶，将 0.2ml 等分试样放置在 6 个载玻片上。样品不接受注射、生理盐水注射或 RHH（2.5、5、10 或 20 个单位）。最耐 RHH 的凝胶在第七个载玻片上接受 40 个单位的 RHH。在多个时间点从鸟瞰和侧视图用标尺拍摄凝胶照片。
瑞蓝 -L 和瑞蓝丽瑅是最容易溶解的 HA 填充剂。两者对 2.5 个单位的 RHH/0.2ml 均有明显反应。乔雅登 Ultra、贝洛特、瑞蓝丝丽和瑞蓝缇颜对 RHH 有中度抵抗力。瑞蓝唯瑅、乔雅登 Ultra Plus、薇乐、薇拉美和乔雅登 Voluma 抵抗性最强，需要超过 20 个单位的 RHH/0.2ml 才能完全溶解。乔雅登丰颜至 20 个单位的 RHH 时有中度抵抗性，但用 40 个单位的 RHH 时表现出明显的溶解性。
本研究直观且客观地展示了 HA 对透明质酸酶溶解的体外反应。填充物分为对 RHH 的最小、中等和最大阻力。有趣的发现包括用于类似适应症的产品（如瑞蓝丽瑅比乔雅登 Voluma 更液化）液化程度明显不同，以及贝洛特易于变平但保留质地。结合体内数据，这可能有助于计算用于控制和部分逆转市售 HA 凝胶所需的透明质酸酶剂量。
