Why Wouldn't Hyaluronidase Work for Dissolving Juvederm?

Question

I've have had 2 series of injections to remove Juvederm around the corners of my mouth and have gone to 2 separate plastic surgeons to do this. It dissolved some above the upper lip where it wasn't supposed to, but nothing where it needed to. There are still palpable and visible lumps and columns of juvederm around my smile. I never looked this strange before. Is it common to take several tries and would it be risky for me to have hyaluronidase injected again in the same places?

Richard H. Tholen, MD, FACS · Answer

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!

Jason Emer, MD · Answer

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

Anil R. Shah, MD · Answer

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

Harold J. Kaplan, MD · Answer

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.

Mehryar (Ray) Taban, MD, FACS · Answer

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.

Why Wouldn't Hyaluronidase Work for Dissolving Juvederm?

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Answer: Knowing what is the problem

Answer: Knowing what is the problem

Answer: Hyaluronidase

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Why Wouldn't Hyaluronidase Work for Dissolving Juvederm?

Answers (8)

Answer: Knowing what is the problem

Answer: Knowing what is the problem

Answer: Hyaluronidase

Answer: Hyaluronidase

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Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.