Table 2.

Hyaluronidase dosage and considerations for treating complications of facial filler injections.

Aesthetic indication	Hyal dosagea	Hyal dosage (authors’ experience)	Considerationsb
Tyndall effect	10-75 iuc [2,34]	≤150 iu	Nature of HAd filler (eg, cross-linked) Patient’s wish to maintain cosmetic benefit of filler injection
Noninflammatory nodules (overfilling or misplacement)	5-150 iu [21,25]	≤300 iu or more, depending on severity and filler type and volume	Nature and location of filler Volume of filler to be degraded
Asymmetry or contour irregularities	As above	≤225 iu	As above
Inflammatory nodules	500 iu every 48 hours to be administered after OABe have been tried for ≥2 weeks [39]; 30-300 iu combined with OAB [40]	Variable; often in conjunction with other treatments	Results of skin biopsy Results of microbiology testing (if nodule fluctuant or abscess) Nature of HA filler (eg, cross-linked)
Vascular occlusion	450-1500 iu total (high-dose protocol) [60] in up to 4 Hyal cycles; 35-50 iu under HFUSf guidance (low dose protocol) [6]	300-1000 iu or more, depending on size of ischemic area	Nature of HA filler (eg, cross-linked) Size of ischemic area Embolus size Timing of intervention Patient factors (eg, scar in the area) HFUS imaging availability

^aMultiple Hyal sessions are often required, and the provider may use incremental dose adjustments depending on the response.

^bConsiderations are crucial to decision-making and building an individualized approach to Hyal therapy.

^ciu: international unit.

^dHA: hyaluronic acid.

^eOAB: oral antibiotics.

^fHFUS: high-frequency ultrasound.