Best method to inject hyaluronidase in widespread area? (Photo)

Question

2 mos ago during filler appt, the injector feathered in some filler around my lower, RT cheek- “with a cannula.” He only did this on the RT side, as he felt it was not as full. Now, two mos later, I am left with my RT cheek looking double the size compares to the LT. I am devastated. I am desperate to get this removed. Because it’s not one specific spot of filler and it’s feathered in… My question is “what will be the best method to remove it?” Dissolver with a cannula? Diluted hyaluronidase?

Raffy Karamanoukian, MD, FACS · Answer

Filler migration and permanence is a very common problem because there are many different types of HA fillers on the market and each is specified for a specific part of the face. Use of highly cohesive fillers on thin skin may cause swelling and nodularity. If patients have filler migration or nodules, we recommend a combination approach of filler reversal with enzymes Hylenex and Hyaluronidase in different strengths to dissolve the filler. We may also need to add Kenalog to the mix in order to reduce fibrous tissue. If the filler does not dissolve, it either means the filler is not HA material or we need more enzyme. The HA reversal can be combined with other lasers and skin treatments at the same time, and it usually (usually) does not affect adjacent tissue.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Afternoon! Sorry that you're experiencing trouble with your filler. In my opinion, if you want it all gone, you need to "flood" the area with hyaluronidase to get it to all dissolve. I dissolve with a needle rather than cannula as it tends to be more focused. Some will advocate for diluted hyaluronidase, though I don't choose to do this myself. If you're looking to reduce, but not completely eliminate, I would recommend small amounts over 1-2 weeks to get the result you may want. Hope this helps you!

Best method to inject hyaluronidase in widespread area? (Photo)

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Best method to inject hyaluronidase in widespread area? (Photo)

Answers (2)

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Everything you need to know about Hyaluronidase

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