For any medical professional working with hyaluronic acid (HA) dermal fillers, having immediate access to a reliable hyaluronidase enzyme is non-negotiable. Hyaluronidase is essential both for correcting aesthetic outcomes and, critically, for managing vascular occlusion (VO) emergencies. Liporase® (typically supplied as 1500 International Units or IU) is a widely used brand of powdered hyaluronidase in many aesthetic markets. Its effectiveness and safety depend directly on proper reconstitution and dilution. This article provides a practical guide for aesthetic practitioners on the principles of Liporase reconstitution for common clinical applications.

Understanding Liporase® Hyaluronidase (1500 IU)

Liporase® contains the enzyme hyaluronidase, provided as a lyophilized (freeze-dried) powder in a vial, typically containing 1500 IU of enzymatic activity. The specific source (e.g., ovine) may be indicated on the packaging. Its mechanism is to break down HA polymers, liquefying the gel, which is why it is used for dissolving HA filler.

Why Correct Reconstitution is Crucial

Properly preparing Liporase® is fundamental:

• Dosage Accuracy: Ensures the correct enzyme concentration (Units/mL) is achieved for predictable results, whether making precise adjustments or managing an emergency.
• Sterility: Maintaining strict aseptic conditions during preparation prevents bacterial contamination of the solution, which could lead to infection upon injection.
• Efficacy: Correct dissolution ensures the hyaluronidase powder is fully dissolved and active, allowing it to effectively break down HA.
• Safety: Minimizes errors in preparation that could lead to ineffective treatment (particularly dangerous in VO) or adverse reactions related to improper handling.

Standard Reconstitution Procedure for Liporase® (1500 IU)

Adhere to a rigorous sterile technique throughout the entire process:

• Required Materials:
  • One vial of Liporase® 1500 IU.
  • Sterile 0.9% Sodium Chloride (Saline) for Injection. Preservative-free saline is generally preferred for injectables.
  • Appropriate sterile syringes (e.g., 1ml, 3ml, 5ml, 10ml) and sterile needles for drawing up the saline and the final solution.
  • Alcohol swabs or other suitable antiseptic for cleaning vial tops.
  • Sterile gloves.
• Aseptic Technique: Wash hands thoroughly and put on sterile gloves. Clean the rubber stopper of the Liporase® vial and the saline vial (or ampoule neck) with alcohol swabs and allow to dry completely.
• Adding the Diluent: Using a sterile syringe and needle, draw up the desired volume of sterile saline based on your target concentration (see next section). Inject the saline into the Liporase® vial. It is best to aim the stream of saline against the glass wall of the vial to minimize foaming.
• Mixing: Gently swirl or invert the vial until the lyophilized powder is completely dissolved. Do not shake vigorously, as this can denature the enzyme protein.
• Inspection: Before drawing up the solution, visually inspect the vial to ensure the solution is clear and free of any visible particles.
• Calculating Concentration: The concentration in Units per milliliter (IU/mL) is calculated by dividing the total units in the vial by the total volume of saline added: 1500 IU / (mL of Saline Added) = Concentration (IU/mL). This is key to understanding your hyaluronidase dilution.

Common Dilution Strategies for Different Applications (Principles & Examples)

The concentration of reconstituted hyaluronidase depends on whether it’s for elective correction or emergency management. Always remember these are examples of commonly discussed international practices; rely on your specific training, clinical assessment, and judgment. There is no single universal “correct” dilution for all situations.

A. Elective Dissolving (Nodules, Asymmetry, Overfill)

• Goal: Precise, controlled breakdown of unwanted HA filler.
• Common Concentration Range: Often prepared at lower to moderate concentrations to allow for targeted injection of smaller volumes. Commonly discussed concentrations may range from 150 IU/mL to 500 IU/mL.
• Example Dilutions for a 1500 IU Vial:
  • Add 10mL Saline → 150 IU/mL
  • Add 5mL Saline → 300 IU/mL
  • Add 3mL Saline → 500 IU/mL
• Rationale: Lower concentrations allow for more precise injection volumes for targeted treatment areas. This approach may allow for titration over sessions if complete dissolution is not desired in one go. Understanding these options aids in knowing how to prepare hyaluronidase 1500 IU for specific cosmetic adjustments.

B. Emergency Vascular Occlusion (VO) Management

• Goal: Rapid, widespread diffusion of a high enzyme concentration to dissolve intravascular or compressive HA filler immediately. This is an emergency requiring aggressive action.
• Common Concentration Range: Often prepared at higher concentrations to deliver a potent dose quickly using sufficient volume to flood the area. Commonly discussed concentrations may range from 750 IU/mL to 1500 IU/mL or even higher in some established protocols.
• Example Dilutions for a 1500 IU Vial:
  • Add 2mL Saline → 750 IU/mL
  • Add 1mL Saline → 1500 IU/mL
• Rationale: Delivers a high dose of active enzyme rapidly into the compromised area and surrounding tissue. Using larger volumes (“flooding”) helps ensure diffusion throughout the affected zone. Multiple vials (e.g., 3-5 vials immediately, repeated) are often necessary for robust treatment in a VO emergency. Knowing the protocol for hyaluronidase concentration for VO is lifesaving. It’s vital to follow established emergency protocols learned in certified training.

Storage and Stability After Reconstitution

As Liporase® and the sterile saline used for reconstitution typically lack preservatives, the reconstituted solution has limited stability.

• Common Practice: Many practitioners use reconstituted hyaluronidase immediately. If storing for short periods, keep under refrigeration (typically 2-8°C).
• Discard: Discard any unused reconstituted solution after the timeframe specified in any available manufacturer information or based on established local pharmacy guidelines for reconstituted biologics (often within 24 hours, but verify). Do not freeze reconstituted solution.

Important Considerations & Best Practices

• Allergy Potential: Be aware of potential hypersensitivity reactions to hyaluronidase (ranging from local to rare systemic). Consider performing a patch test prior to elective dissolving if clinical suspicion is high or per local guidelines/training.
• Labeling: Clearly label the syringe with the concentration (IU/mL) and the date/time of reconstitution to avoid errors.
• Calculations: Double-check all volume and concentration calculations before drawing up and administering the solution.
• Training: Never use hyaluronidase without specific, adequate training in its reconstitution and administration for both elective and emergency use.

Sourcing Authentic Liporase®

Ensuring the hyaluronidase product you have on hand is authentic, sterile, and contains the stated IU dosage is critical. Obtain genuine Liporase® only from reputable suppliers such as Health Supplies Plus. Be vigilant against counterfeit products, as ineffective hyaluronidase in a VO emergency can have devastating consequences.

Conclusion

Proper reconstitution and appropriate dilution of Liporase® 1500 IU hyaluronidase are fundamental steps for its safe and effective application in aesthetic practice. Understanding the different concentration strategies for elective dissolving versus critical Vascular Occlusion management is essential.

While this guide provides core principles and examples, practitioners must always rely on their specific training, meticulous sterile technique, careful calculations, and sound clinical judgment to ensure they are prepared to use this vital enzyme effectively and safely when the need arises.

Doris Dickson

About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.

 

Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.