How much Vitrase is needed to remove this much Voluma? Or should I leave it alone till it finally goes away? (Photo)

Had filler in December. Now my smile is asymetrical and my cheeks are too close to my eyes. I went to a plastic surgeon's office where he has a nurse doing injections. She has training certificates, but I feel now I look awful and overdone. There are 3 syringes total of Voluma in cheeks and chin. And 2 syringes total of regular juvederm in naso-labial folds and temples. I did NOT have this problem before. Included is a before photo as well. I plan on going to another doctor.

Doctor Answers 8

Overdone cheeks with Voluma and Juvederm need hyaluronidase

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I wouldn't worry about the dosing, leave that up to the doctor removing the Voluma.  Your cheeks appear to have too much filler.  The problem with hyaluronidase is that it isn't very precise.  So removing a portion but not all of the Voluma is not easy.  You will probably get lumpy and asymmetric with the hyaluronidase and it will take at least a few treatments.  Voluma and Juvederm are more difficult than Restylane and Perlane to dissolve. Training certificates should be a red flag, can be obtain over a weekend.  Board Certifications in Facial Plastics, Plastic Surgery, or Dermatology should be what you look for.

Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews


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Hello Jlm3c, 

Thank you for your question.

Without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of any further treatments it is difficult to be comprehensive.

Vitrase or Hylenex are enzymes that act to dissolve the filler.  This is not a perfect science but when done carefully you may be able to shape and contour without dissolving all the filler.  This is dependent on the technique used in injecting the filler as well as the enzyme.

I would seek out an appointment with a physician injector.

Best of luck,

Dr. S

Scott Shadfar, MD
Edmond Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

How much Vitrase is needed to remove this much Voluma?

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In almost every case, fillers can be refined with Vitrase/ Hyaluronidase/ Hylenex without needing to remove all of the product. Voluma does respond to Hylenex treatment but is highly cross linked and thicker so it tends to require a higher dose. The amount that you would require depends upon exactly where and how much filler needs to be reduced. I would recommend consulting in person with a physician injector who has extensive experience with fillers AND hyaluronidase. This is something I do alot of and am truly passionate about. A small amount of contouring of a bad filler result can actually save the day and make someone happy with removing all of the product. I wish you the best.

Vitrase to help Dissolve Voluma: Difficult because of cross-linking

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Vitrase or Hyaluronidase is a naturally produced enzyme which can be injected into the area of a hyaluronic acid filler to help dissolve the filler. Voluma is highly cross linked and will take a significant amount of Vitrase to dissolve it, though it is possible. Sometimes some patience is as effective as Vitrase injections because it can lead to further asymmetry and is not a precise procedure. Juvederm should decrease in volume in the next 3 months and Voluma may take a bit longer. 
Treatment for overfilling or asymmetry can be difficult, but presenting to a plastic surgeon with significant experience with fillers and their correction is important! I perform all of my own injections and have throughout my career which these days is unique, though when there are complications I know how to treat them.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Removal of Voluma with hyaluronidase

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I am sorry to learn that did not achieve the outcomes from injection that you had hoped.  Soft tissue volume augmentation can be extraordinarily helpful in producing natural and youthful outcomes but can also change your appearance depending on the goals and outcomes determined ahead of time.  

Voluma can be removed using hyaluronidase.  It is somewhat more resistant to hyaluronidase than some other fillers are so it may take several treatments in order to achieve your desired outcome.  You indicate that you plan on going to another doctor.  I would bring photographs of yourself when you were younger to review with the doctor. and try to be as specific as possible when telling the doctor what it is you would like to try to change.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 43 reviews

Should I get Vitrase

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Well, you basically have 5ml of filler in varying areas. It will take several rounds of Vitrase to remove it all, without a doubt. The key to Vitrase/hyaluronidase is to be conservative. Remember that fillers and injectables have no idea what to do on their own. The results depend on the injector and the technique. You can have a training "certificate" after a 1 day, few hour course. This does NOT make you skilled or an artist. I would suggest consultations with other physician injectors for advice.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Voluma and hyaluronidase and Vitrase

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Our office specializes in Vitrase injections in Los Angeles. We incorporate a conservative dosage algorithm to help improve symmetry after filler overinjection. 

Dr. Karamanoukian 
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews


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I would go back to the office where you had the injections and let them start reversing it for you.  One advantage of Voluma is that it can be reversed but will likely take several injections to get it where you are happy.  I would ask to see the physician and explain what you are unhappy with.  I hate to see you spend more money by going to another physician.

Melanie L. Petro, MD
Birmingham Facial Plastic Surgeon
4.7 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.