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The main risk for using hyalase to reverse dermal fillers to stop impending necrosis is allergic reaction.
Others believe that you can also lose natural volume (your natural hyaluronic acid) – I can believe that this may be truer the older the client, but I have never experienced it clinically.
The message that gets out there is that it depletes hylaronic acid and therefore you’re losing something that was there all along. But that’s only a temporary thing, it’s made on a continuous basis. I sometimes compare it to hair growth but much faster, or an escalator – it’s continuously being churned out.
So, within 36 hours the hylaronic acid will be replaced. There may be a dip initially, but it should be full restored in a week.
Apart from the allergy, it’s a very safe medication.
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Hyalase and the cross over between wasp and bee allergies.
There is always a risk of your patient having an anaphylactic shock when injecting hyalase.
But, having looked up the contents of a bee sting there are actually hundreds of different compounds and just one of them is hyalase. The idea being that the toxin has evolved in order for it to spread further in the body, so they could be allergic to any of those compounds. It isn’t necessarily the hyalase that’s the most allergic so it’s a little bit of a flag, but it’s not to say there is a massive crossover, I don’t think.
In which case, I’d always recommend doing a patch test of hyalase before injecting.
Why would you recommend doing a patch test of hyalase in an emergency situation?
Yes, it’s controversial because a lot of people don’t recommend it – I think even ACE guidelines don’t.
But I’m recommending for you to consider your environment, consider what you would do if our patient had an anaphylactic reaction and take that all into account when you’re thinking about the risks of performing a hyalase allergy test.
With a vascular occlusion, in my opinion you’ve got time, as I believe you’ve got hours not minutes before tissue necrosis happens. And an anaphylactic reaction is far more serious than necrosis.
What if they do have an allergic reaction to hyalase and they’ve also got necrosis?
You can implement the rest of the Emergency Reverse Protocol and refer them to hospital. But I’d keep an eye on that allergy test and see what happens because if you are anaphylactic, you think it would be a much clearer reaction, it’s not going to be a faint little bump.
If you’re used to doing an allergy test when you are hyalasing someone, (most people will do so in a busy aesthetics clinic with 100s of patients in an elective situation) that should build up a sense of what a real allergic reaction looks like.
So, you’d hope that within the context of overall good practice, assessing that reaction will be quite clear.
Do you think it’s controversial to recommend doing an allergy test before administering hyalase? Comment with your thoughts below.