Why Wouldn't Hyaluronidase Work for Dissolving Juvederm?

Hyaluronidase (Wydase) is an enzyme that helps to break down Hylauronic Acid, which is what the HA fillers Restylane and Juvederm are made of. It's also a normal part of human tissues. Unfortunately, when too much HA filler is injected, or when it is injected in areas where we really didn't want it, or migrates with massage or excessive facial activity, too many doctors simply think Wydase is a simple "antidote," and seek to "break down" the offending filler by injecting this enzyme. Patients are thereby led to believe that a little Wydase will solve imprecise or inartistic or excessive filler injection. Plus, the patient pays for the (excess) filler, and again for the Wydase! Who is THAT good for? Artistry and conservatism is more important than selling another syringe! You can always have more, but who wants to overshoot and then have to try to "dissolve" it?

The reality, however, is that the manufactured HA fillers are intentionally crosslinked to enhance their stability and longevity in human tissue. Otherwise, the filler would not "last" very long. Thus, the fillers are designed to be resistant to breakdown so they provide wrinkle "fill" and volume enhancement for as long as possible. This very intentional characteristic makes the injected HA fillers much more resistant to Wydase breakdown compared to the normal hyaluronic acid in our tissues, which is less crosslinked naturally.

When Wydase is injected, the natural hyaluronic acid in our tissues breaks down more than the offending injected HA filler, so although the total tissue volume is indeed decreased somewhat, what really remains is more of the crosslinked manufactured injected HA filler you paid your doctor for.

Your situation clearly shows this response, and is why my best recommendation is to hold off on any further injections for now, let things settle over many months, and then find an injector that will be conservative, precise, artistic, and not over do things so much that the next advice is enzyme to break down the "excess." Best wishes!

Thank you for your question! Firstly, Hyaluronidase only works to dissolve fillers composed of Hyaluronic acid. If your filler was not made up of that, Hyaluronidase will not work. Second, there is a probability that if you wait too long to get the Hyaluronidase into the affected area, then it may not work and you would need to seek out other treatment options. Since it's possible that  this filler cannot be dissolved with Vitrase / hyaluronidase, a combination of fractional laser or radiofrequency, Venus Legacy treatments, and 5FU/steroid injections could help with removing whatever filler is left in treated area. Otherwise, aside from waiting to see if it goes away, the only other permanent option is surgical removal. I suggest seeing an expert for a formal consultation. Best, Dr. Emer  

There are several reasons for hyaluronidase not to work including:-Filler has begun to be replaced by collagen.  Filler including HA's is ultimately replaced by a degree of collagen.  Collagen typically does not reduce with hyaluronidase-The area of concern is not due to filler.  There are normal bumps and irregularities in the face.  It is possible that the bumps you feel are parts of your normal anatomy.  Bumps can normally be felt in some lips-Wrong concentration/ placement-  The wrong concentration of hyaluronidase will not be effective as will wrong placement.Seek advice from an expert injector.  Best Dr. Anil Shah

Like Dr. Taban suggested, it may be that the Juvederm did dissolve but, in doing so, left areas that weren't filled any longer which may lend to an undesirable outcome. Another possibility is that the correct amount of hyaluronidase was not used. Technique as it pertains to amount and placement is important when dissolving with hyaluronidase. If done correctly with patience and gentle manipulation, the end benefits are usually immediate if not within 24 hours.

Hyaluronidase will dissolve any Juvederm present, if injected in correct amount. There is no known risk to your health. The two folds in the corner of your mouth appear to be folds, and not Juvederm; hence, hyaluronidase is not working. Another reason might be if there is scar tissue present. Good luck.

Thank you for your question. Hyaluronidase(Wydase) is often used to degrade HA filler that have been injected and specifically cross-linked to prevent their natural breakdown.The dosage required is dependent on several factors relating to the HA filler; whether it is particulate or non-particulate, the amount of cross-linking, and the concentration of HA. Different HA fillers have differing physical properties that influence their degradation by hyaluronidase in a time- and dose-dependent manner.  A recent study has shown that Belotero was the fastest to dissolve and Juvederm Voluma®  and Restylane®Lyft were the slowest,  concluding that hyalronic acids with a high concentration of HA, larger particle size, and increased cross-linking increases the durability of the filler. Be aware it can actually break down your bodies own natural hyaluronidase and this may have something to do with what you are experiencing. 
The literature and my experience sggest many different doses . I usually start with .2 to .5 and then I inject as much hyaluronidase as required to obtain the desired effect rather than following an absolute dosage. So the the amount injected should be titrated to clinical effect. Repeating up to three times is valid.
I hope this helps
Gail Humble MD

Juvederm and more particalarly juvderm plus require higher doses of hyaluronidase to dissolve compared to other fillers.If the lumps are truly filler it is most likely a dosage issue. It is normal to get some natural hyaluronic acid temporarily breaking down ( adjacent area)but this quickly regenerates. If it is indeed filler , then a higher  and repeated dose may be required .It this does not resolve the issue , I would be questioning the diagnosis of the lumps eg is it granuloma formation ?However given the symmetry this would be unlikely. Is it your pre filler status and now that you are looking at yourself more critically , you have noticed them .Pre treatment photos are most useful in this situation and can often prove our memories wrong!

Thank you for your question. Hyaluronidase will certainly dissolve Juvederm if present and if injected in the correct dose. However, the two folds in the corner of your mouth appear to be folds and not Juvederm, therefore hyaluronidase will not work. I recommend having a follow up with your treating physician to address any concerns you may have. Best of Luck!