Handfield Chelsea, Hooper Deirdre, P Wyles Saranya
J Drugs Dermatol. 2025 Mar 1;24(3):303-306. doi: 10.36849/JDD.8428.
Hyaluronic acid (HA) fillers offer an advantage in being easily reversible with enzymatic hyaluronidase administration. Yet, there are no clear guidelines regarding the amount of hyaluronidase that should be administered given that commercially available fillers differ in constituent properties.
Six HA fillers were mixed with aliquots of human recombinant hyaluronidase (0 mL, 0.1 mL, 0.2 mL, and 0.3 mL). Filler dilution photography was obtained with the addition of various doses of hyaluronidase. Final filler and hyaluronidase mixture was then visualized on light microscopy at 40X magnification.
None of the fillers responded to the direct addition of hyaluronidase alone. Active mixing was required to stimulate the enzymatic effect. Restylane products which have equal concentrations at 20 mg/mL exhibited similar rates of dissolution. In contrast, Juvederm products, which differ in concentration, exhibited variable rates of dissolution. Juvederm Volbella (15 mg/mL) was the most easily dissolvable filler, in contrast, Juvederm Ultra (24 mg/mL) was the least easily dissolvable filler. Microscopically, Juvederm fillers appeared more refined whereas the Restylane fillers appeared more globular following hyaluronidase.
This study demonstrates the in vitro response of different HA fillers to hyaluronidase. Each filler exhibited a variable dose effect. HA concentration (mg/mL) was the critical variable in determining the rate of hydrolysis. Therefore, HA concentration may be an important factor when calculating the dose of hyaluronidase needed to reverse HA fillers. J Drugs Dermatol. 2025;24(3):303-306. doi:10.36849/JDD.8428.
透明质酸（HA）填充剂具有一个优势，即通过注射酶促透明质酸酶可轻松逆转。然而，鉴于市售填充剂的成分特性不同，对于应注射的透明质酸酶剂量尚无明确指南。
将六种HA填充剂与不同等分的人重组透明质酸酶（0 mL、0.1 mL、0.2 mL和0.3 mL）混合。添加不同剂量的透明质酸酶后拍摄填充剂稀释照片。然后将最终的填充剂和透明质酸酶混合物在40倍放大倍数下进行光学显微镜观察。
单独直接添加透明质酸酶时，没有一种填充剂有反应。需要进行主动混合以激发酶促作用。浓度均为20 mg/mL的瑞蓝产品表现出相似的溶解速率。相比之下，浓度不同的乔雅登产品表现出不同的溶解速率。乔雅登Volbella（15 mg/mL）是最易溶解的填充剂，相比之下，乔雅登极致（24 mg/mL）是最难溶解的填充剂。在显微镜下，注射透明质酸酶后，乔雅登填充剂显得更精致，而瑞蓝填充剂显得更呈球状。
本研究展示了不同HA填充剂对透明质酸酶的体外反应。每种填充剂都表现出不同的剂量效应。HA浓度（mg/mL）是决定水解速率的关键变量。因此，在计算逆转HA填充剂所需的透明质酸酶剂量时，HA浓度可能是一个重要因素。《药物皮肤病学杂志》。2025年；第24卷，第3期：303 - 306页。doi:10.36849/JDD.8428 。
