摘要

Objectives: This article summarises the key findings from our research, recently published in Plastic and Reconstructive Surgery Global Open, which represents the largest study on filler dissolving to date. This Presentation will describe for the first time, the Posthyaluronidase Syndrome, a symptom complex describing negative aesthetic outcomes after hyaluronisdase The study offers valuable insights into patient demographics, treatment indications, hyaluronidase dosing, and patient outcomes, with a focus on identifying optimal dosing strategies and independent predictors of poor outcomes, Introduction: The widespread use of hyaluronic acid dermal fillers in medical aesthetics has led to an increase in filler-related complications. Emerging evidence suggests that some fillers may persist in tissues for over a decade, leading to a growing number of patients seeking corrective treatments. Hyaluronidase, is widely used to dissolve HA fillers. Of particular concern is the Posthyalase Syndrome, characterised by unfavourable changes such as facial hollowing and wrinkling. The fear of such adverse effects often deters both patients&practitioners from pursuing dissolving therapy. Materials / method: Our retrospective study reviewed 157 cases in which hyaluronidase was used to dissolve fillers in the periocular region, reflecting the fact we are a specialised oculoplastic centre. This is the largest such series ever published. A detailed history was taken for each patient regarding past injectables and pre-treatment photographs were taken. The area of interest was first inspected and then palpated. The incidence of postyaluronidase syndrome was recoded and regression used to identify independent predictors of poor result. Results: Posthyalase syndrome occurred in 18% of cases, with no correlation to hyaluronidase concentration or dose. There was also no correlation with patient age, gender or location of filler. Instead, the syndrome was linked to the original filler’s characteristics. Two significant predictors were identified: the duration the filler had been in place before dissolution (p=0.00019) and the volume of filler used (p= 0.000017). The average duration that the filler had been in situ was 5 years in patients with the Posthyalase Syndrome. The mean filler volume was 4 mls Conclusion: These findings highlight the importance of thoroughly evaluating a patient’s filler history before proceeding with hyaluronidase treatment. Patients with long-standing or high-volume fillers should be informed about the increased risk of posthyaluronidase syndrome. The use of imaging techniques like ultrasound or MRI is highly recommended to accurately assess filler volume and location before initiating treatment. All patients having hyaluronidase therapy should be warned that there is an 18% risk of developing a posthyaluronidase syndrome.