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Hyaluronidase or Amphadase, Hylenex, Vitrase aka Hylo


What is the most important information I should know about hyaluronidase (Amphadase, Hylenex, Vitrase)

Your doctor/nurse may perform a skin test to see if you are allergic to hyaluronidase before you receive the medication to reverse unwanted filler, undesirable results or a complication. We will not refill your filler on or within 24hrs to 1-2 weeks (s) per our protocol(s).


Before receiving hyaluronidase, tell your doctor/nurse if you are using any of the following drugs: furosemide (Lasix); phenytoin (Dilantin); a sedative or anxiety medication (such as Valium, Xanax, Tranxene); aspirin or salicylates; cortisone or ACTH (Corticotropin); estrogens; or an antihistamine (such as a cold or allergy medicine).



Over the past 60 years, hyaluronidase has been successfully utilized in ophthalmic surgery and is now being implemented in dermatosurgery as well as in other surgical disciplines. The enzyme is considered a "spreading factor" as it decompresses hyaluronic acid (also called hyaluronan, HA), an essential component of the extracellular matrix (ECM). When applied as an adjuvant, hyaluronidase enhances the diffusion capacity and bioavailability of injected drugs. Therefore, the enzyme has been used as a local adjuvant to increase the diffusion capacity of local anesthetics, increasing the analgesic efficacy, and the anesthetized area particularly in the first minutes following injection, resulting in diminished intra- and postoperative pain. In aesthetic medicine, the off-label use of hyaluronidase is considered the gold standard for the management of HA-filler-associated complications.

  • Hyaluronidase is a genetically designed protein.

  • Hyaluronidase is used as an aid in helping your body absorb other injected medications.

  • Hyaluronidase may also be used for purposes not listed here.



-Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

-Less serious side effects may include pain, itching, redness, swelling or burning feeling where the medication was injected.

-Call your doctor/nurse immediately for medical advice about side effects. -Side effects can also go as long as 2-3 days, call the clinic if this occurs.

-Asymmetry can happen however your injector is skilled enough to correct it.



We keep our hyaluronidase refrigerated 2-8C


I understand that this is a cosmetic treatment and payment is my responsibility. There is a fee for EACH injection procedure performed by this clinic.

Have you reviewed the Pre/ Post Care Instruction portion in this document? If you have not reviewed the Pre/Post Care Instructions please read above now. You cannot receive treatment until you have read through the pre and post-care instructions. After you have read through the instructions and asked any questions to your provider please circle here in order to proceed with this consent.



Notify your provider PRIOR TO SIGNING THIS CONSENT if any of the following apply to you:

  • Allergies to Bee stings or Bee pollen

  • Cold sores(or history), warts, open skin lesions, sunburn, extreme sensitivity, dermatitis, rosacea

  • Blood thinning medications

  • Accutane or generic version within the past year

  • Pregnant or breastfeeding

  • Received chemotherapy or radiation therapy

  • Collagen Vascular Disease

  • Eczema, Psoriasis, Dermatitis, Keloid/hypertrophic scarring

  • Hemophilia I bleeding disorders

  • History of autoimmune disease or any condition that may weaken your immune system

The clinic may use a numbing agent for your comfort level.

Please use a check mark after you have read and agreed upon the following:

______    _                            HA overcorrection is possible and the applied volume of hyaluronidase
should not exceed the estimated volume of the overcorrection in order to avoid complete degradation of the effect of HA augmentation. Ideally, hyaluronidase should be injected gradually in small volumes and, when necessary, over multiple sessions in order to achieve the desired extent of correction and prevent overtreatment.

_                                            Even though results can be significant, I have been informed that many

practices of cosmetic medicine are not an exact science and that no guarantees can be or have been made concerning the expected results in my case. (Multiple treatments may be necessary to achieve optimal results.)

_____                               I will only wash my face with warm water before bed or within 8 hours of my treatment and not an abrasive cleanser or one that contains AHAs or BHAs.

Before and after photos are necessary and even mandatory at Lotus MDs©Queensway Medical Clinic. Client pictures are stored and saved for the provider's reference. Pictures will be kept on file electronically minimum of seven years. Lotus Mds©Queensway is bound by a signed contract keeping patient information private in addition to ethical guidelines.


This list is not meant to be inclusive of all possible risks associated with Plasma as there are both known and unknown side effects associated with any cosmetic procedures, additionally expect that your practitioner may use this product or determine the use for the off-label treatment depending on the degradation or ageing severity or location of the skin or hair condition.


By signing below, I acknowledge I have read this "Informed Consent" and agree to the treatment with its associated risks.

Thanks for submitting!
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