Understand and Use Hyaluronidase Properly

📊 Hyaluronidase Misuse vs. Proper Use Comparison Table

Category	❌ Misuse of Hyaluronidase	✅ Proper Use of Hyaluronidase
Purpose of Use	Vague dissatisfaction ‘Let us just dissolve everything’	Based on clear indications (Excessive filler, lumps, asymmetry, complications)
Diagnostic Process	Procedure without anatomical evaluation	Determined after analyzing filler location, depth, and volume
Dosage Setting	Using unnecessarily high doses	Gradual use starting from the minimum effective dose
Injection Site	Wide area, random injection	Localized and precise injection into the problem area
Treatment Interval	Repeated administration at short intervals	Additional injection if necessary after observing the reaction
Anatomical Understanding	Administered without distinguishing between muscle and fat layers	Considering filler location (subcutaneous/supramuscular/submuscular)
Result	Temporary excessive volume loss Unnecessary hollowing	Restoration of natural lines
Perception of Side Effects	Misunderstood as ‘Hyaluronidase ruined my face’	Recognizing that the issue lies in the method of use
Long-term Impact	Increased anxiety, fear of retreatment	Safe retreatment possible if needed

Does hyaluronidase spread so well that matching the layer is unnecessary?

1️⃣ Hyaluronidase is a drug with strong ‘diffusion capacity’ → Correct

To summarize the characteristics of hyaluronidase:

Breaks down the hyaluronic acid matrix

Widens the interstitial space between tissues

Spreads relatively quickly to surrounding tissues after injection

👉 Therefore,

✔ Even if you do not pierce exactly into the filler in ‘one shot,’

✔ It acts on HA fillers in adjacent layers.

This statement itself is a fact.

2️⃣ Why the ‘layer concept’ is still important

The core point is this 👇

Hyaluronidase spreads, but it does not spread ‘evenly across all layers.’

Reason ① Tissue barriers are different

The skin layer / subcutaneous fat / muscle / fascial layers

👉 Have different diffusion resistance.

Especially around the fascia / dense fibrous septa / retaining ligaments,

→ Diffusion is restricted.

=> Thinking ‘it will spread anyway, so roughly doing it is fine’ may be insufficient for fillers at different depths!

Reason ② The ‘abnormal layer’ where the filler entered is the problem

The layer where the filler should have properly entered + the layer where it entered abnormally—both must be acted upon.

✔ That is correct.

Therefore, hyaluronidase must be approached by ‘distinguishing the layers’ even more carefully.

For example:

Situation	Required Hyaluronidase Approach
Normal layer (e.g., supramuscular fat)	Standard dose, localized
Too shallow layer (intradermal)	Low dose, surface refinement
Too deep layer (submuscular / periosteal)	Deep targeted injection
Mixed layers (migration)	Multiplanar approach

👉 If you just spray it into one layer,

✔ It acts excessively on some layers,

✔ And insufficiently on others.

3️⃣ The ‘diffusion capacity’ of hyaluronidase requires a strategy

The diffusion capacity of hyaluronidase does not mean ‘you can give up on accuracy,’ but rather

👉

**‘Inject accurately, and it can cover the surrounding area as well.’**

The point repeatedly emphasized in Landau’s paper is:

Localized action

Temporary enzyme activity

As much as needed in the required area

In other words,

🎯 You set a target and ‘utilize’ the diffusion; 🎯 You do not just expect it to spread without a target.

4️⃣ Summary in actual clinical practice

Hyaluronidase is a drug with good diffusion capacity, but it is not a drug to be used while ignoring anatomical layers. Rather, the more the filler is mixed between normal and abnormal layers, the more a hyaluronidase approach considering the multiplanar structure is necessary.