Is it normal to not see hyaluronidase work instantly to remove some filler in the nose? Does it sometimes take longer?

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hyaluronidase is an enzyme that dissolves fillers made of hyaluronic acid (Juvederm, Restylane, etc).  The results are usually seen within minutes, however it is normal to have swelling and possible bruising at the jevtion site.  Are you able to provide a before and after photo?

How fast Hyaluronidase dissolves hyaluronic acid (HA) fillers varies on the make-up of
the filler. However, not all lumps after HA injections are filler. They can be
small hematomas or bruising. These can take several weeks to resolve. 

So either there is some remnant filler that will respond to the second injection in the next 12-24 hours. The other possibility is that the remaining lump is a little scar or foreign body granuloma (scar reaction)These are not made of filler so will not respond to filler dissolving agent. If the lump still hasn't gone after the second hyalase injection then i recommend you go away and massage the area firmly twice a day for a couple of months then ask your specialist to consider hyalase again. This should go some way to sort the lumpiness out for you. Hope that helps Adam Goodwin

Hyaluronidase injections to remove excess filler starts working immediately after injection, however the full results may not be visible for a few weeks, after all of the swelling from the procedure itself has resolved.Typically patients see results from hyaluronidase  treatments within 24-48 hours.  However, I do wait 2 weeks to evalute the full- effect and to assess if additional treatments are required.

The speed with which hyaluronidase dissolve HA fillers varies on the composition of the filler.  Some dissolve much more slowly and less effectively than others.  Also, not all lumps following filler are filler alone, they may be small hematomas or bruises that can take weeks to resolve.

Hyaluronidase, an enzyme that breaks down hyaluronic acid, can be used to dissolve hyaluronic acid based fillers such as the Restylane and Juvederm line of products. While hyaluronidase does go to work immediately, the full results can take up to 72 hours to manifest. It is not uncommon to need several rounds of hyaluronidase to completely rid of unwanted filler, especially for fillers such as Perlane (also known as Restylane Lyft) that consist of a larger, more dense molecule.

I suggest you give the hyaluronidase a couple more days, and follow up with your physician if the results are still not to your liking; more product may need to be injected at that time. Best of luck!