How to Use Hyaluronidase: Clinical Pearls


Joel Cohen, MD

Derek Jones, MD

Dr Joel Cohen and Dr Derek Jones, two of the leading experts in cosmetic dermatology, provide us with some important information on the use of hyaluronidase…


  1. Many clinicians consider hyaluronidase as standard of care, i.e., it is in the office.
  2. Be aware with Voluma because it is a vycross technology not a hyal-cross technology—therefore, its not as easy to dissolve with hyaluronidase, so it may take more concentration.
  3. It takes a fair amount of hyaluronidase to erase nodules with Voluma.
  4. How much hyaluronidase should you use? Some use 150 units per mL;  A simple rule of thumb for each 10th of a cc of Restylane, use about 5 units of Vitrase; (remember that the units across every brand may not be the same); 10 units if you’re trying to dissolve Juvederm; and probably about 15 units for Voluma.
  5. A bottle of Vitrase has 200 units per bottle-so you actually do have to reconstitute with some things so you get more out of it.
  6. Hyalnex is 150 units per bottle.
  7. The shelf-life for the hyaluronidases is very short.
  8. Many people use compounded products, but we’re not sure if they are as effective.
  9. There are a lot of issues with compounding and there will be a lot more regulations coming up.