A topical issue

Prollenium® recently acquired Topilase®, the first 100% natural topical hyaluronidase, describing it as “one of the most exciting innovations in cosmetic aesthetics in decades.” We spoke to Dr Emily Mehta about its applications

Topilase® is the first topical hyaluronidase enabling treatment adjustment without injections. It is made of a combination of enzymes concentrated within a dispersing agent, helping it permeate the skin successfully, with the benefit of five additional natural ingredients – cistus, myrrh, lavender, aloe vera, and helichrysum essential oils to restore, soothe, purify, revitalise and regenerate.

The product was invented by cosmetic doctor, international trainer, author and innovator, Dr Sandrine Sebban, who wanted to develop a safe and efficacious method to address skin contour irregularities.

While Topilase® is not a replacement for injectable Hyalase for medical complications or in an emergency situation, such as a vascular occlusion or infection, it offers an alternative for appropriately selected patients for minor corrections and refinements.

Dr Emily Mehta, medical director of Story Clinics and Harley Academy, who has been one of the practitioners using the product prior to the official UK launch, explains, “Injectable hyaluronidase can be used either in an emergency scenario or in a planned scenario.

In an emergency scenario, or when there’s a medical complication, such as a nodule or infection, and you need to remove any associated filler, injectable Hyalase is still the only option. However, hyaluronidase is also used quite frequently for minor corrections.

After injection

After Topilase

Or sometimes, in some people, the product just doesn’t all break down evenly. So people might have tear trough filler that’s three years old, and there’s just a little bit left, and it’s not quite smooth.

In these scenarios, using small amounts of hyaluronidase to correct things is quite common. Topilase® is really a potential alternative for the right person for when you’re doing minor corrections or more little perfections of how the filler’s sitting.

One of the main advantages of using a topical product for refining treatments is that it removes the risks associated with injectable hyaluronidase, including local allergic reactions (incidence 0.05- 0.69% rising to 31.3% with 200,000 IU) and rare urticaria and angioedema (incidence < 0.1%).

“Injectable Hyalase has risks, so you don’t want it to be your fail-safe eraser”, says Dr Mehta. “It’s still better to be cautious with how you’re injecting, and under injecting and top up rather than thinking, ‘Well, it doesn’t matter.

I can just Hyalase it.’ Because you can get quite bad bruising, allergic reactions or swelling, and it can be quite uncomfortable for the patient. If you use large amounts of injectable hyaluronidase, you can temporarily decrease skin quality. It’s obviously impacting your endogenous hyaluronic acid.

So regardless of Topilase®, I think hyaluronidase should be used judiciously. If you have a case that will respond to the topical one, it’s lower risk, so there’s no good reason not to use it.”

Topilase® is sold in 3ml bottles with a dosing tip for ease of application and minimal wastage.

The enzyme complex within the product contains protease, lipase and hyaluronidase known to help break down HA chains. On average, patients require three treatments one week apart.

“Often, it can take more than one application of the product. Maybe two or three”, says Dr Mehta. “If you want to do each application yourself, they’ll have to come to clinic two or three times instead of once. However, because it’s a cosmetic product, not a prescription medicine, you could instruct your patient on how to apply it at home.

“They would just have to wear gloves, and you’d have to give them some careful information. In my clinic, I would get them to sign something to say they understand how to use it.

Topilase® won’t penetrate deep, so you know that it will not affect filler placed deep down. It’s only going to affect filler that’s in the skin or just under it.”

Case selection is the most important factor. “It’s very useful for the right case. For the wrong case, it will just not work”, says Dr Mehta. “You have to use it only when the filler is superficial; if the filler is sitting on the bone, then Topilase® isn’t going to do anything.

The enzyme complex within the product contains protease, lipase and hyaluronidase known to help break down HA chains

After injection

After Topilase

Also, if the filler has been there for years, it’ll be harder to dissolve. So the ideal case is when you’ve got a nice, soft, goodquality filler that hasn’t been injected too long ago, and you just want to smooth out any lumps and bumps or remove little hard edges or little bits of migration. It works really nicely for that.”

Dr Mehta also thinks it presents an opportunity for perfecting and enhancing results. “When practitioners talk about Hyalase, they often talk about correcting other practitioners’ work because they don’t want to talk about correcting their own work.

“Topilase® is an opportunity to perfect or enhance results. It might be you’ve done someone’s lips, and they come back for review four weeks later, and they’re 95% perfect.

There’s just one vermilion border that’s a little bit fuller than the other. So there is the potential opportunity to use Topilase® in that way as an outcome perfecter for something so minor that you’d never consider using injectable Hyalase on it. 

The patient might not even be that bothered about it or bothered at all, but you can potentially use it to perfect your own work, and that’s what I’m interested in.

“There are some cases where it is an alternative to injectable Hyalase, but there are other cases where it’s an alternative to doing nothing, which is great because it can give better results.”