Hyaluronidase Use in Aesthetic Medicine: Formulations, Safety, and Clinical Practice

The 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.