Alam M, et al. - Authors evaluated the efficacy and dose-related impact of small quantities of hyaluronidase to treat hyaluronic acid filler nodules. However, hyaluronic acid fillers could be removed from patient skin with very small doses of hyaluronidase, slightly higher doses often resulted in more rapid resolution.

Methods

• Experts conducted a split-arm, parallel-group, randomized clinical trial at an urban academic center.
• They included 9 healthy women.
• From February 2013 to March 2014, recruitment and follow-up occurred; From February to July 2016, data analysis occurred.
• Aliquots (buttons) of either of 2 types of hyaluronic acid fillers were received by each participant into bilateral upper inner arms, respectively.
• Each button was treated with a constant volume (0.1 mL) of variable-dose hyaluronidase (1.5, 3.0, or 9.0 U per 0.1 mL) or saline control, at 1, 2, and 3 weeks.
• Main outcomes and measures were both a blinded dermatologist and the participant independently assessed detectability.

Results

• As per data, 72 treatment sites on 9 women (mean [SD] age, 45.8 [15.7] years) received all interventions and were analyzed.
• Findings suggested that there was a notable difference in physician rater assessment between saline and hyaluronidase at 4 weeks (visual detection: mean difference=1.15; 95% CI, 0.46-1.80; P < .001; palpability: mean difference=1.22; 95% CI, 0.61-1.83;P < .001) and 4 months (visual detection: mean difference=0.77; 95% CI, 0.33-1.26;P=.001; palpability: mean difference=0.82; 95% CI, 0.38-1.25;P < .001) that was mirrored by participant self-assessment at 4 weeks (visual detection: mean difference=0.87; 95% CI, 0.26-1.48;P=.006; palpability: mean difference=1.59; 95% CI, 1.41-1.77;P < .001) and 4 months (visual detection: mean difference=1.31; 95% CI, 1.09-1.53;P < .001; palpability: mean difference=1.52; 95% CI, 1.03-2.01;P < .001), and hyaluronidase was associated with greater resolution of buttons compared with normal saline.
• Researchers noted that compared to the 1.5-unit sites, the 9.0-unit hyaluronidase injection sites were significantly less palpable at both 4 weeks (mean difference=0.50; 95% CI, 0.01-.99;P=.045) and 4 months (mean difference=0.47; 95% CI, 0.14-0.81;P=.007).
• For Restylane-L, dose dependence was more notable.