Madison Hyaluronidase doctors

I would agree with the two posts thus far, but will add another thought.  H'dase is dose dependant, so it is possible that a little more will get you more results.  It depends on the original dose your physician used, and it's location relative to the filler.  So follow up with your physician, and discuss the possibility.  You are right, it can have it's influence within a day or two under normal circumstances.

If that is not the case, then I too would be suspicious of the filler.  I am already truthfully.  I would strongly advise you to pursue this with your friend, since you are unhappy and have issues.  Knowledge is power here.  There is an outside chance that low dose steroid injections with kenalog might be of value instead, but make sure you know what you are dealing with as a filler before considering this. 

The answer to your question is that hyaluronidase does not typically dissolve enough of your native hyaluronic acid (HA) to show as a depression at the strength and concentration we use.

Think of it this way.  HA as a filler is injected in a bolus, or larger but discrete deposit that sits outside of the cells of our body.   When HA'ase is injected to dissolve this, the total dose and concentration are chosen to provide enough drug to access and rapidly dissolve that defined collection.  The antidote is placed in direct or near direct contact with the undesired deposit. 

Two, normal HA is throughout our body, both inside and outside of cells.  Our homeostatic mechanisms are constantly degrading and restoring it, so we have active mechanisms at work at all times to keep those levels roughly the same.  HA'ase will have less influence on this active, steady state part of our body.

Three, HA'ase is used as an addition to other drugs like lidocaine in order to increase their diffusion after injection.  With that use, we do not see depressions or furrows or irregularities due to localized HA'ase degradation of normal HA. 

So the summary is that we do not expect to see any obvious effect on normal native HA with HA'ase injections.

I have patients massage after hyaluronidase for two reasons. One is to disperse the hyaluronidase a little, and cover the area of unwanted HA injection while feathering into the surrounding tissue. Two, it helps the unwanted HA break down and resorb. You should know that hyaluronidase works very quickly, often times within a 1-3 day span, so if you don't see resolution, you should check back with your injectionist.

It also can induce a little swelling of it's own, so give it some time. Finally keep in mind that the speed and total effect of hyaluronidase is based on dose. If things are not dissolving quickly enough, you might just need more hyaluronidase.