Hyaluronidase: the enzyme that dissolves hyaluronic acid filler.

If you do not know what was injected, that matters — and it is one of the things imaging helps with, though ultrasound shows that something is there and its shape and depth, and cannot always identify which product it was.

How “per area” works. An area is an anatomical zone on one side of the face, not a single structure. The under-eye and cheek on one side are one area, so filler that has moved from the tear trough into the cheek is one charge, not two.

Migrated lip filler. $150 scan, credited toward treatment → $500 total.

Under-eyes and cheeks, both sides. $150 scan, credited toward treatment → $1,000 total.

More than one session. Large volumes and long histories are often staged across more than one session. A repeat session is priced by quote, and we tell you up front if we expect you to need one.

Skin test. When one is needed (see wasp stings, below), it is included in the treatment price. If no treatment follows, it is $100, which covers the hyaluronidase vial.

The other hyaluronidase products sold in the United States are extracted from animal tissue. Hylenex is a fully human form of the enzyme, made by recombinant technology rather than extracted from cattle or sheep testicles [1].

That is a difference in origin, not a promise. It does not make an allergic reaction impossible, and it does not change the screening in the next section.

We ask every patient whether they have ever had a serious reaction to a wasp or bee sting. It sounds unrelated. It isn’t — hyaluronidase is itself one of the allergens in wasp and bee venom [2]. Someone sensitized by a sting can, in principle, react to therapeutic hyaluronidase for the same reason, and a history of a serious sting reaction is recognized as a higher risk [2] [3]. If you have that history, we skin-test first. If you don’t, testing is decided case by case.

A skin test checks for an immediate reaction. It cannot rule out a delayed one, which can show up a day or more later [4], so we tell you what to watch for afterward either way.

The one exception: in a suspected vascular occlusion, treatment is not delayed for testing [3].

Using hyaluronidase to dissolve dermal filler is off-label. That is true of every hyaluronidase product sold in the United States, including Hylenex — they are approved to help fluids and other injected drugs disperse and absorb, not to reverse filler [1] [4]. We would rather tell you that than not.

We image the area first, then inject the hyaluronidase into and around the filler with a series of small injections. Swelling and bruising afterward are expected.

Most of the visible change happens within 24 to 48 hours, and the area settles over about two weeks [3].

For a while it can look flatter than it did before you ever had filler. That is temporary over-deflation: the enzyme also breaks down some of your own hyaluronic acid, which your body replaces [3]. It resolves.

Call us if swelling, redness or itching comes on or gets worse a day or more after treatment. Usually it is ordinary swelling; occasionally it is a delayed allergic reaction, and that needs treating rather than waiting [4].

When dissolving does not work, it is usually for one of four reasons.

• The filler was not where it was assumed to be. Hyaluronidase is broken down quickly in the tissue, so it works close to where it is injected [4]. Filler that has moved is not where it was put.
• It was not hyaluronic acid. The enzyme does nothing to Sculptra, Radiesse, Bellafill or silicone.
• The dose was too small for the volume present. Years of treatment can leave more filler in place than anyone expects, and firmer, more cross-linked products take more to break down [4].
• It was not filler. Scar tissue and an inflammatory nodule can look and feel like filler, and an enzyme that breaks down hyaluronic acid does nothing to either.

Most of these can be seen on a scan before anything is injected. Not all of them: ultrasound shows that something is there, its shape and its depth, and it cannot always say which product it is. More on imaging on the ultrasound-guided filler dissolving page.

Patients come to Newport News for this from across Virginia and northeastern North Carolina — Richmond, Virginia Beach, the Eastern Shore, the Outer Banks and the Triangle. We do the imaging and the treatment in the same visit, so the trip is one trip. Tell us when you book that you are driving a distance.

Not sure what’s actually in there? The ultrasound scan is $150, and it comes off the treatment if you decide to go ahead the same visit.

Book the $150 scan →

1. HYLENEX recombinant (hyaluronidase human injection). Prescribing information, revised November 2024. DailyMed
2. Bertlich M, Hartmann D, Freytag S, French LE, Oppel E. Sensitization against medical hyaluronidase in patients with confirmed hypersensitivity against hymenoptera species and its clinical implications. Br J Dermatol. 2024;191(6):1000–1007. PubMed · doi:10.1093/bjd/ljae290
3. King M, Convery C, Davies E. The use of hyaluronidase in aesthetic practice (v2.4). J Clin Aesthet Dermatol. 2018;11(6):E61–E68. PubMed · Full text
4. Jung H. Hyaluronidase: an overview of its properties, applications, and side effects. Arch Plast Surg. 2020;47(4):297–300. PubMed · doi:10.5999/aps.2020.00752