Dear Dr. M,
I appreciate your tough position and concern. Hydrelle and its complications have been a huge problem. I continue to get emails, phone calls and messages on my website blog from excellent experienced doctors like yourself as well as patients. The company has been in denial for the most part although their CEO did admit some issue to me during a phone call. What I hear from other doctors is that the company representatives continue to sound surprised when an experienced doctor calls them with concerns.
My own patients are mostly fine and have moved past this as I stopped injecting Hydrelle many months ago and went back to Juvederm and Restylane, especially now that they come with added lidocaine.
I am treating a patient who had Hydrelle injected in another state and then moved to DC and now is under my care.
I will post this message and the main empirical protocol I came up with for treating Hydrelle complications on my website for others to see as well since I get these emails very often and it may be helpful for others in similar situations to see what seems to work.
- Hydrelle complications follow in the acute and delayed category
- The acute Hydrelle complication is usually swelling and redness.
- Oral antibiotics help reduce the inflammation
- Oral steroids may be useful but have risks
- Hyaluronidase injections to dissolve the Hydrelle are useful
- The delayed reactions seem to occur at 4-6 weeks after injections
- The presentation may be lumps or initial swelling
- As some point lumps seem to appear. These may appear little by little and not all at once.
- Oral antibiotics are useful
- Oral steroids may be useful but also have risks
- Hyaluronidase injections are important to dissolve the Hydrelle molecules
- Kenalog injections may be useful, especially at the beginning. These may leave divots or depressions and should be used conservatively.
- Aspiration of sterile abscesses may be needed at some point as the lumps are often granulomas or sterile abscesses.
- The Hyaluronidase injections can also cause a sensitivity reaction that is does dependent. Take that into account
- The Hyaluronidase injections may be needed once a week or even more for several weeks
- Steroid injections may be needed as well but I don’t do them more than once every 2-3 weeks usually. Be careful with this.
I typically mix 1cc of Hyaluronidase (150u-200u/cc) with 1cc of 2% Lidocaine with epinephrine with 0.5cc of K40 steroid to make a 2.5cc mixture. I use a 27g needle with a 3cc syringe.
- I inject deep to avoid damage to skin
- I often leave the kenalog out for subsequent injections
Frequent follow up is necessary
It’s a tough problem but it is fixable completely or near completely with lots of time and attention. The Hyaluronidase is not cheap. Your patients need to know this was not due to your error but rather as a result of the product.
*** These are treatments that have worked for me. They have not been scientifically studied. You should do what you feel is right and feel comfortable doing and not take these suggestions as “advice.”
You should also report adverse reactions to the FDA by filling out the online form:
Dear Dr. Naderi,
I wish I had known about the Hydrelle problems earlier. I amd now seeing a patient whom I injected in
January and she just came in the day I was leaving for a conference. I just got back to the office so it was a total of 12 days since I first saw her. I have been injecting fat and fillers for many years and this is the
first time I have had any problems. The hard masses reminded me of a patient seen during training that
had silicon injections to the face in another country and eventually needed expanders and excision for
reconstruction. Needless to say this patient has been daily in my mind and made my time away not so enjoyable as I wondered how she would be when I returned. Since I would be away I did not want to inject with anything as I could not see her if any further problems developed. I treated her with the Dermsound that has
an untrasonic feature and did some massage of the areas with this and gave her one of the new Opal clarisonic home devices that have ultrasound for her home use.
I called your office today to try to get some idea of how to treat this patient as the Coapt company could
offer no specific treatment, could not direct me to where to get any hyaluronic acid or how to use it and told
me they had rare complaints such as mine. I have always been so careful with patients and ” to do no harm” .
I thank your office for letting me know where I could get hyaluronic acid but would like to know how I should
go about injecting it and how much and how often. Some of the areas are 2 cm by 3cm and others 0.5to 0.7 cm.
Do I combine with Kenalog and if so what type of combination and how often to inject?
I did some added ultrasound today and she will continue with the home Opal device. The areas remain hard
but a bit less noticable until touched.
I would appreciate any help with this case and thank you for your efforts with Coapt. I have 12 boxes of the
stuff and I am not using it on anyone else.