ARTICLE | AESTHETIC SOLUTIONS | Figure 6 Tyndall effect
Granuloma Granuloma, a reddish swollen tumour on the site of injection of hyaluronic acid, is secondary to an immune reaction against the polymer. The patient in Figure 8 received a cross-linked hyaluronic acid injection to the malar area a few months previously, and without any problem. A strong inflammatory reaction associated with a local granulomatous reaction appeared a few days after a thermogenic radiofrequency treatment. As visible in Figures 8 and 9, the whole area was swollen and the entry points of the previous implant appeared swollen and red. The patient was treated with three careful successive injections of low doses of ovine hyaluronidase, with a complete return to her normal appearance after the third injection. No side-effects were noted immediately or even some weeks after the injections.
Figure 7 Correction of Tyndall effect following treatment with hyaluronidase
around the eyes, wanted the change in colour to be
removed. Hyaluronidase was injected, very superficially, in order to place the product exactly inside the non-accepted coat of hyaluronic acid. Hyaluronidase was diluted in 4 ml saline solution and, after an intradermal allergy test, 0.2 ml were released in three retro-injection lines: 75 IU of hyaluronidase were therefore injected on each side. Figure 7 shows the result 30 minutes after the superficial injection. A further correction can be carried out, but the delay for a new correction has not yet been defined. The authors prefer to wait for at least 1 week between hyaluronidase injection and a new hyaluronic acid implant.
Conclusions Cross-linked hyaluronic acid fillers are actually widely used in aesthetic medicine. Hyaluronic acid is considered a very safe implant but nevertheless, can result in some side-effects. Hyaluronidase is a simple treatment that gives an immediate result, rubbing out excesses and even granuloma. It is also used for melting fibrotic areas. Hyaluronidase should therefore be included in our therapautic armamentarium against the side-effects of hyaluronic acid. The main concern for using hyaluronidase is a possible allergic reaction, making an intradermal test necessary before every treatment.
Declaration of interest None declared Figure images 1–9 ç Ph. Deprez and E Ranneva
Hyaluronidase is a
simple treatment that gives an immediate result, rubbing out excesses and even granuloma.
Figure 8 Granuloma of hyaluronic acid appeared after local thermogenic treatment
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Figure 9 Result after treatment with three injections of low-dose ovine hyaluronidase
April/May 2012 |
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