Combined Application of Hyaluronidase and Collagenase for Late-Onset Edema in Periocular Area After Hyaluronic Acid Volume Repositioning: A Six-Case Retrospective Review.

Background and Objective: Although generally low-risk, hyaluronic acid (HA) dermal fillers can lead to late-onset edema, particularly in the periocular region. This condition typically manifests three to four months post-injection and requires specialized management, usually with hyaluronidase. However, increased use of hyaluronidase has resulted in instances of post-hyaluronidase syndrome, leading to unaesthetic outcomes. This study presents a retrospective case series that utilizes a novel technique combining two enzymes to improve late-onset edema and prevent post-hyaluronidase syndrome development.
Methods: From 2019 to 2024, six patients in our aesthetic clinic received a novel therapeutic approach involving co-administration of 1,500 IU of hyaluronidase and collagenase with a cannula to address late-onset edema in the periocular area.
Results: The combination of high-dose hyaluronidase and low-dose collagenase improved late-onset edema in all patients after a single treatment. Statistical analysis showed a significant improvement in aesthetic scores (P < 0.05), with effect sizes of 0.89 for Hirmand, 1.3 for the Teoxane Infraorbital Hollows Scale (TIOHS), and 1.2 for O'Mahoney's photo-numeric scale. No post-hyaluronidase syndrome or complications were observed.
Conclusions: This combined technique utilizing 1,500 IU of hyaluronidase and collagenase GH PB220 from Pbserum (Madrid, Spain) effectively achieves significant aesthetic improvements with a high safety profile, offering a promising alternative for managing late-onset edema after HA dermal filler treatments.
Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
(Copyright © 2024, Castelanich et al.)