Hyaluronic acid (HA) based cutaneous filling substances have become the treatment of choice for facial volumization. Hyaluronidase is a soluble protein that promotes the enzymatic degradation of HA. Commercially available preparations differ according to the substance's origin (bovine, ovine or human recombinant). Although cosmetic use has not yet been approved by the FDA, off-label use in dermatology is increasingly common. The purpose of the present article is to review the medical literature and prescribing information (package inserts) over existing commercially available products in order to provide an up-to-date view of the indications, dosage, injection techniques, and adverse effects.

Keywords: HYALURONIC ACID; HYALURONOGLUCOSAMINIDASE; ESTHETICS; OFF-LABEL USE

Hematomas are common following cosmetic surgery. When minor, they are treated with observation only as they are most often reabsorbed. However, even with small collections of blood, if no early intervention is adopted, poor aesthetic outcomes may occur. Early drainage has been especially described in otorhinolaryngology and radiology journals. The authors present an approach to early treating hematomas. Special emphasis is given to the use of hyaluronidase, which is well known by dermatologists and plastic surgeons for its ability to dissolve hyaluronic acid, but its utility in the treatment of hematomas is not so commonly known by these experts.

Keywords: Hyaluronoglucosaminidase; Hyaluronic Acid; Hematoma; Fibrosis

Esthetic dermatology is a growing field, and different noninvasive therapies are gaining attention. The objective of this narrative review was to update current evidence-based knowledge about recombinant enzymes. The PubMed, SciELO, Cochrane Central, and Imbiomed databases were searched for meta-analyses, systematic reviews, randomized controlled clinical trials, observational registries, and preclinical data published in English, Spanish, and Portuguese. Effectivity, safety, and tolerability of recombinant hyaluronidases, lyases, collagenases, and lipases, including their combinations, were evaluated and confirmed in diverse indications. Further research could increase current knowledge on this constantly developing and promising therapeutic area.

Keywords: Liases; Colagenase microbiana; Hialuronoglucosaminidase; Lipase.

This case report describes a complication following the use of a filler composed of hyaluronic acid and calcium hydroxyapatite mixed in the same syringe, resulting in vascular occlusion of the right transverse facial artery. The patient developed hypopigmented macules, followed by a reticulated pattern and pustules. Treatment included prednisone, enoxaparin, and hyaluronidase. Due to worsening symptoms, including arterial obstruction confirmed by ultrasound, ultrasound-guided hyaluronidase injection and hyperbaric oxygen therapy were administered. The patient showed a favorable recovery, with regression of vascular complications. This case underscores the importance of early identification and intervention to minimize complications associated with vascular occlusion in aesthetic procedures.

Keywords: Dermal Fillers; Hyaluronoglucosaminidase; Arterial Occlusive Diseases.