Dermal Filler Reversal Protocol
HAUS OF ÄSTHETIK
DERMAL FILLER REVERSAL PROTOCOL
DATE OF IMPLEMENTATION: 1ST APRIL 2025
REVIEW DATE: 1ST APRIL 2026
VERSION NUMBER: 1.1
INTRODUCTION
This protocol ensures the safe and effective reversal of hyaluronic acid (HA) dermal fillers using hyaluronidase, covering both elective and emergency cases. It follows MHRA, Save Face, JCCP, and GMC guidelines while integrating best practices for patient safety.
Only Doctors, Dentists, and Registered Nurses with advanced training in aesthetic medicine and emergency complication management may administer this treatment. A face-to-face consultation is mandatory before elective reversal.
INDICATIONS FOR REVERSAL
Elective Reversal (Non-Emergency):
• Patient dissatisfaction with filler results (e.g. asymmetry, overcorrection).
• Filler migration leading to aesthetic concerns.
• Lumpiness or nodules not resolving with massage.
• Water attraction (Tyndall effect) causing increased volume or swelling.
• Overfilled appearance that is not resolving naturally.
Emergency Reversal (Medical Indications):
• Vascular Occlusion (VO) – Persistent blanching, absent capillary refill, pain.
• Filler-induced necrosis – Skin breakdown, ulceration, worsening pain.
• Intravascular injection symptoms – Severe bruising, dusky skin, or immediate mottling.
• Severe inflammatory reaction or infection – Hard, red, warm swelling with fever.
• Allergic reaction to filler – Immediate or delayed hypersensitivity (swelling, rash, itching).
PREPARATION OF HYALURONIDASE SOLUTION
Step 1: Reconstitution of Hyaluronidase
• Standard Reconstitution:
• Use 1500 IU vial of Hyalase.
• Mix with 1.5-2ml bacteriostatic saline or sterile saline for effective dispersion.
• Resulting concentration: 750-1000 IU/ml.
• Higher Dilution (for minor corrections):
• Mix 1500 IU with 4-5ml saline to create lower potency for subtle dissolving.
• Emergency Reversal (Vascular Occlusion):
• Mix 1500 IU with 1.5-2ml saline for immediate, high-potency effect.
• Use small volume of lidocaine (optional) to reduce patient discomfort.
ELECTIVE REVERSAL PROCEDURE
Step 1: Consultation & Informed Consent
• Discuss indications, risks, and expected outcomes.
• Assess previous filler placement and any existing complications.
• Conduct patch test (optional) if history of anaphylaxis.
• Take pre-procedure photographs for documentation.
Step 2: Allergy Test (Optional)
• Inject 0.01ml (tiny bleb) of hyaluronidase intradermally on the forearm.
• Inject 0.01ml saline as a control next to it.
• Observe for raised, red, itchy reaction (suggestive of hypersensitivity).
Step 3: Injection Technique for Elective Dissolving
• Inject hyaluronidase into the exact filler placement depth.
• Use a fanning or linear threading technique to distribute the enzyme evenly.
• Massage the area gently to encourage dispersion.
• Expected results: Filler starts breaking down within 24 hours, with complete effects in 7-14 days.
EMERGENCY REVERSAL PROCEDURE (VASCULAR OCCLUSION)
Step 1: Identify the Signs of Vascular Occlusion (VO)
• Pale, white, or dusky skin (blanching).
• Sluggish or absent capillary refill.
• Increasing pain and tightness in the area.
• Cool skin temperature compared to surrounding tissue.
• Progressing mottling or bruising in a vascular pattern.
Step 2: Immediate Actions
• Stop injecting immediately if VO is suspected.
• Apply warm compress to encourage vasodilation.
• Massage firmly to help dislodge any occluding filler.
• Administer 300mg of soluble aspirin (if no contraindications) to help prevent clot formation.
Step 3: Emergency Hyaluronidase Administration
• Inject 1500 IU hyaluronidase mixed with 1.5-2ml saline.
• Place small boluses around and within the occluded area.
• Massage firmly for 5 minutes, apply warm compress, reassess capillary refill.
• Repeat hyaluronidase every 15-20 minutes as necessary, up to 3 doses within 2 hours.
• Monitor for signs of skin improvement – colour returning, capillary refill improving.
Step 4: Post-Treatment Protocol
• Prescribe antibiotics if tissue damage has occurred (e.g., Co-Amoxiclav or Doxycycline).
• Consider oral steroids (Prednisolone 30mg for 3-5 days) to reduce inflammation.
• Review the patient within 24-48 hours and continue monitoring for any worsening.
MANAGEMENT OF ALLERGIC REACTION TO HYALURONIDASE
• Mild Reaction (Local Redness, Itching, Swelling)
• Apply antihistamine cream (e.g. Chlorphenamine).
• Administer oral antihistamines (Cetirizine or Loratadine).
• Monitor for further reaction for 30 minutes.
• Moderate to Severe Anaphylaxis (Breathing Difficulties, Wheezing, Facial Swelling)
• Administer IM Adrenaline (0.5mg 1:1000 into the thigh).
• Call 999 immediately.
• Lay patient flat and elevate legs.
• Administer oxygen if available.
• Give antihistamines and corticosteroids as per emergency protocol.
POST-PROCEDURE CARE
• No additional filler should be injected for at least 14 days.
• Patients should avoid excessive heat, alcohol, and vigorous exercise for 24 hours.
• Swelling, bruising, or mild tenderness may occur but should resolve within a few days.
• Follow-up appointment at 2 weeks to assess results and discuss further options.
DOCUMENTATION & RECORD-KEEPING
• Record batch number, dosage, injection sites, and any adverse reactions in patient notes.
• Obtain signed informed consent prior to treatment.
• Take before and after photographs for reference.
• If an emergency reversal was performed, document all emergency interventions taken.
EMERGENCY CONTACT & AFTERCARE
For any concerns or adverse reactions, patients can contact:
• Emergency Line: 07514 543015 (WhatsApp available for photos/videos of reactions)
• Email: HausOfAsthetik@icloud.com
• Clinic Address: 4 Portland Square, Water Street, Bakewell, Derbyshire, DE45 1HA
FINAL NOTES & REGULATORY COMPLIANCE
• This protocol aligns with MHRA, JCCP, Save Face, and GMC guidelines.
• Practitioners must undergo continuous training in vascular occlusion management.
• Emergency equipment, including adrenaline, antihistamines, and oxygen, must be readily available.
• All adverse events must be reported via the MHRA Yellow Card Scheme.