Hyaluronidase in Puebla

What is hyaluronidase?

Hyaluronidase is an enzyme that dissolves hyaluronic acid. It is injected to correct or reverse a filler made with hyaluronic acid —when it ended up excessive, poorly placed, forming lumps or migrated from its site— and it is the only treatment able to undo that kind of filler in a controlled way, without surgery.

It is worth being honest from the first line: hyaluronidase works only on hyaluronic acid fillers. It does not dissolve calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate or silicone. So before injecting anything, one must know with certainty what material was placed: a filler that is not hyaluronic acid does not respond to this enzyme, and promising otherwise deceives the patient.

Hyaluronic acid is also a natural part of the skin. The enzyme can temporarily affect a small amount of the skin’s own hyaluronic acid in the area, which the body regenerates over the following days or weeks; it does not permanently destroy tissue.

There is one scenario that is not aesthetic but urgent: when a filler compresses or occludes a blood vessel, hyaluronidase is used as an emergency treatment to free the vessel and prevent skin necrosis or, in the highest-risk areas, damage to vision. In that context it is not an aesthetic whim: it is emergency medicine, and time matters.

Techniques Dr. Arístides Arellano uses

This is not a device or a machine: hyaluronidase is an enzyme, and what changes the result is the clinical judgement with which it is used. The approach adapts to whether the problem is aesthetic or urgent:

• Identify first which filler was placed. Before injecting, it is confirmed that the material is hyaluronic acid. If it is not —or is unknown— it is not applied blindly.
• Low, staged dosing for aesthetic correction. It is easier to dissolve a little more in a second session than to give back filler already broken down; erring on the conservative side and adjusting is preferred.
• High-dose emergency protocol for vascular compromise. When there are signs a vessel is occluded, the logic reverses: act fast, with doses sufficient to restore circulation.
• Correction of the Tyndall effect. Filler placed too superficially leaves a bluish tone under the skin; dissolving it precisely resolves that discolouration.
• Managing nodules and migration by palpation. The build-up or displacement of material is located and the enzyme is directed to that specific point.
• Assessing allergic risk. Hyaluronidase can cause hypersensitivity reactions; previous allergies are asked about and, when the case advises it, a sensitivity test is considered before the full dose.

How is it performed?

Hyaluronidase is applied through micro-injections into the area where the filler to be dissolved sits. It is an outpatient procedure that usually takes a few minutes, requires neither an operating theatre nor general anaesthesia, and the patient walks out the same day.

First the area is assessed and it is confirmed that the filler is hyaluronic acid. For an aesthetic correction it is preferable to start with low doses and, if needed, repeat a few days later: the enzyme cannot be titrated with millimetric precision, so dissolving in stages is safer than overshooting at once. The effect begins to show within the first 24 to 48 hours and may complete over one or two weeks.

In a vascular occlusion the conduct is different: it is injected promptly and at high doses around the compromised vessel, because the goal is no longer to fine-tune aesthetics but to save the tissue. This is one reason these injectables should be given where there is capacity to recognise and treat the complication, not merely to place them.

Hyaluronidase can provoke hypersensitivity reactions, from redness and local swelling to —uncommonly— a more significant allergic reaction. That is why allergies are asked about, including allergy to bee stings, and why it is applied in a setting prepared to manage a reaction. After application, swelling, redness and sometimes a small bruise at the injection points are expected.

Every medical treatment —topicals, peels and energy-based devices included— carries risk and requires a prior assessment. In darker skin (Fitzpatrick IV–VI, the most common phototypes in Mexico) a poorly indicated procedure can darken the patch instead of lightening it. Results may vary according to each patient, their phototype and their individual triggers.

Who is a good candidate?

A good candidate is someone with a hyaluronic acid filler they want to correct or reverse, who tolerates the enzyme well. In a vascular occlusion caused by filler, hyaluronidase is no longer optional and becomes the emergency treatment. Real candidacy is defined at the consultation, reviewing what was injected and why.

• Hyaluronic acid filler that is excessive, lumpy, asymmetric or migrated out of place.
• Tyndall effect: bluish discolouration from filler placed too superficially.
• Vascular emergency: signs the filler is compressing or occluding a vessel (severe pain, pallor, colour change of the skin). This is a medical emergency.
• Someone who wants to reverse a filler before deciding on a new treatment or injecting again.
• Not a candidate: anyone with a permanent or semi-permanent filler that is not hyaluronic acid, because the enzyme does not dissolve it.
• Caution with a known allergy to hyaluronidase, active infection in the area to treat, or pregnancy; assessed individually.

Recommended post-treatment care

After dissolution it helps to apply gentle cold for the first hours, avoid massaging or heating the area that day, and not re-inject filler immediately: if a new treatment is wanted, the usual course is to wait until the enzyme’s effect completes, around two weeks. See the full guide: Post-surgical recovery and care.

Before and after

Most patients want to see before-and-after photographs before deciding. Out of respect for each person’s privacy, Dr. Arístides Arellano shows real cases —always with documented consent— during your in-person consultation, where you can review results from patients with a starting point similar to yours. Results may vary from patient to patient.

Approximate price

The cost of hyaluronidase is defined at your consultation, because it depends on how much filler must be dissolved, in how many areas, and whether one session or several are required. A vascular emergency is not handled like a scheduled aesthetic procedure. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano. See the price list.

About Dr. Arístides Arellano

Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.

Related patient guide

Choosing carefully whom you trust with your injectables is the best prevention of complications, because whoever places a filler should also know how to resolve it if something goes wrong. Read how to choose your plastic surgeon in Puebla before deciding, or book your consultation.

Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.

Recovery · step by step

• Day 0 — the applicationMicro-injections into the area, an outpatient visit of a few minutes. You walk out. Redness, swelling and sometimes a small bruise at the injection points are expected.
• Hours 24–48The filler begins to dissolve and the area looks less full. The initial swelling settles. Do not massage or heat the area.
• Days 3–7The result is assessed. If an aesthetic correction fell short, this is the time to schedule a second dose. Dissolving in stages is safer than overshooting.
• Weeks 1–2The effect completes. The skin’s own hyaluronic acid that the enzyme may have affected regenerates naturally.
• Before re-injectingIf a new filler is wanted, the usual course is to wait until the enzyme’s effect finishes, around two weeks. Results may vary from patient to patient.

Frequently asked questions

Every figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.

Educational content; it does not replace a medical consultation. Results may vary from person to person.