Changing role of hyaluronidase in plastic surgery

Soft-tissue augmentation has become an increasingly popular option for facial rejuvenation. Hyaluronic acid fillers are part of the most rapidly expanding segment of this market, largely because of their safe drug profile and temporary nature. Despite their good safety profile, they can and do have complications ranging from superficial placement, uneven placement, granulomatous reactions, and skin necrosis. This article reviews the on- and off-label uses of hyaluronidase and presents several clinical algorithms detailing the effective and safe use of hyaluronidase to manage complications secondary to hyaluronic acid fillers.