Cellulase degrades calcium hydroxylapatite filler carrier to reverse vascular occlusion

A study in the *Aesthetic Surgery Journal* published on July 22, 2026, demonstrates that cellulase degrades the carboxymethylcellulose (CMC) carrier in calcium hydroxylapatite (CaHA) fillers, restoring near-complete vascular patency within 60 minutes of occlusion. Using the PULSAR system to mimic microvascular networks down to 200 µm, researchers found that standard hyaluronidase had minimal effect on CaHA-CMC blockages. The trial also highlighted how much volume and dilution dictate risk. A 1 ml bolus of CaHA-CMC carried a 57.1% occlusive potential and a 100% rate of retrograde flow, whereas a 0.2 ml bolus dropped those figures to 16% and 10%, respectively. Additionally, while undiluted CaHA-CMC caused complete occlusion, dilutions of 1:0.5, 1:1, and 1:2 progressively reduced blockage frequency. For clinicians, these findings reinforce the safety of highly diluted, low-volume CaHA placement and introduce cellulase as a prospective, fast-acting rescue agent to watch for non-hyaluronic acid filler complications.

Source: Aesthetic Surgery Journal, https://doi.org/10.1093/asj/sjag151