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Hyaluronidase (Hyal) hydrolyzes HA and is the preferred intervention for HA-filler–related complications. Even though Hyal formulations are considered safe and effective, their use for treating aesthetic complications remains off-label in many countries due to limited standardized protocols and heterogeneous dosing guidance. This review summarizes available formulations, risks, and updated 2020–2025 clinical practice, including dosage and administration strategies, imaging guidance, and adjunctive treatments. It also stresses the need for standardized protocols to improve decision-making, reduce response time, and support successful outcomes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hyaluronidase-use-in-aesthetic-medicine-formulations-safety-and-clinical-practice/462721/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hyaluronidase-use-in-aesthetic-medicine-formulations-safety-and-clinical-practice/462721.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is hyaluronidase used for HA filler complications?","Question",{"text":112,"@type":113},"Hyaluronidase hydrolyzes hyaluronic acid molecules, allowing controlled dissolution. 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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Agorà—Italian Society of Aesthetic Medicine, 20122 Milan, Italy  \n2 Focus Group “Complication”, Agorà—Italian Society of Aesthetic Medicine, 20122 Milan, Italy; [sbellez@libero.it](sbellez@libero.it) (S.B.); [silvicab@gmail.com](silvicab@gmail.com) (S.C.); [maurizio.cavallini@libero.it](maurizio.cavallini@libero.it) (M.C.); [dott.cordovana@gmail.com](dott.cordovana@gmail.com) (A.C.); [dr.riccardolazzari@gmail.com](dr.riccardolazzari@gmail.com) (R.L.); [dottmarcopapagni@gmail.com](dottmarcopapagni@gmail.com) (M.F.P.)  \n* Correspondence: [f.arrigoni@agora.clinic](f.arrigoni@agora.clinic); Tel.: +39-3519753457 † The authors are listed in alphabetical order and contributed equally to this work.  \nAbstract  \nThe rising number of Hyaluronic acid (HA) filler applications has led to an increase in the incidence of complications, which can range from undesired aesthetic outcomes to severe vascular occlusion events. Hyaluronidase (Hyal) hydrolyzes HA molecules and represents the preferred treatment for managing complications associated with HA fillers. Although Hyal formulations are safe and effective, Hyal use for treating complications of aesthetic procedures remains off-label in many countries due to the lack of standardized protocols and varying recommendations on dosing strategies. Here, we review the use of Hyal in aesthetic medicine, focusing on the available formulations, including galenic preparations, and the associated risks. We provide an update on the current clinical practice for Hyal administration by reviewing cases reported in the literature from 2020 to 2025 . We summarize the current dosage strategies and administration techniques for treating different complications, with details on newly developed protocols, the implementation of imaging guidance, and adjunctive treatments. Despite the great variability in dosage and protocols, Hyal administration is a safe and effective treatment to manage complications and undesired aesthetic outcomes caused by HA fillers. Future efforts should focus on developing standardized protocols to facilitate the decision-making process, reduce response time, and ensure successful outcomes.  \nKeywords: hyaluronic acid; dermal filler; aesthetic procedure; cosmetic medicine; complication  \n1. Introduction  \nThe demand for aesthetic and rejuvenation procedures has increased significantly over the past two decades, with hyaluronic acid (HA) being the most popular dermal filler, thanks to its unique properties [1,2] . HA is an optimal candidate for providing hydration, support, and augmentation to tissues like the skin. Being a natural compound, HA is minimally immunogenic, and it is naturally reabsorbed by the body after an average of 12 months, significantly reducing adverse events such as inflammatory reactions [2,3] . However, the rising number of aesthetic interventions led to an increasing occurrence of adverse events, ranging from swelling and filler misplacement to more serious complications, such as nodules, hypersensitivity reactions, or vascular occlusion [1,4] .  \nHyaluronidases (Hyals), a family of enzymes that hydrolyze HA molecules, are essential for managing corrections of undesired aesthetic outcomes and complications from filler procedures, enabling practitioners to dissolve HA in a controlled manner [5] . Although Hyal is widely used in clinical practice, as hi","cbCaikKGod1ZaNLh","https://ap.wps.com/l/cbCaikKGod1ZaNLh","pdf",584656,17,"English","# Introduction\n# Methods","[{\"question\":\"Why is hyaluronidase used for HA filler complications?\",\"answer\":\"Hyaluronidase hydrolyzes hyaluronic acid molecules, allowing controlled dissolution. It is presented as the preferred treatment for managing complications associated with HA fillers.\"},{\"question\":\"Why is Hyal use for cosmetic correction described as off-label in many countries?\",\"answer\":\"The review attributes off-label use to the lack of standardized protocols and the variability of recommendations on dosing strategies, without consistent official guidance.\"},{\"question\":\"What does the review include about current clinical practice?\",\"answer\":\"It summarizes formulations (including galenic preparations), safety considerations, dosage strategies, administration techniques, imaging guidance, and adjunctive treatments for different complications using 2020–2025 literature cases.\"}]","Hyaluronidase Use in Aesthetic Medicine - Formulations, Safety, and Clinical Practice | PDF",1790764990,43]