Does Botox Interfere with Juvederm Dissolving?

Question

I had Botox injections to my crows feet, bunny lines and "11's" and in the same appointment had Juvederm Ultra to fill in tear troughs. Too much filler was injected and also injected in the wrong plane and I now have bags under both eyes. My doctor wants to use vitrase to dissolve filler, however I've been reading some cases where Botox may interfere with lymphatic drainage due to the lack of muscle contraction, resulting in a worse situation. What is your advice?

Harold J. Kaplan, MD · Answer

Good question.  As the panel members suggested, the Vitrase will not effect the outcomes of your Botox treatment regardless if done the same day.

	As you discovered, product and technique are extremely important especially when working in an unforgiving area such as the tear troughs.  We prefer to use only Restylane in this area and are meticulous to not overfill and to place the product under the muscle to avoid the look of bags under the eyes.

	Once your practitioner remedies the problem, you may want to find another injector for tear trough services.  It's also helpful to ask to view before/after photos of one's patients.

Jason D. Bloom, MD, FACS · Answer

The Botox has no effect on being able to dissolve the Juvederm. Vitrase, when injected in small increments, will dissolve the filler without problems. As mentioned earlier, I also do not like Juvederm in this area for a number of reasons, including the fact that it has the ability to swell 6 times more than Restylane.

Edward J. Bednar, MD · Answer

I agree that the vitrase treatment will dissolve the effect of the Juvederm and should not interfere with the Botox.

Kenneth D. Steinsapir, MD · Answer

If your filler service is unsatisfactory, have the enzyme treatment to remove the unwanted filler effect. The Botox service will have not bearing on this service. I personally do not like Juvederm for this location. I prefer Restylane because this product is much more likely to hold precisely where it is placed. It can form a lump so the injector needs to sculpt the product when it is placed but it is unlike to collect under the tear trough which is sometimes seen with Juvederm.

Jeffrey Zwiren, MD · Answer

Botox will have no effect on the longevity of a Juvederm injection. In fact there are studies that show that Botox in the upper lip can enhance the longevity of Juvederm in the upper lip. Atlanta Plastic Surgeon Dr. Z

Teanoosh Zadeh, MD, FRCSC · Answer

Dear Patient,

	It is highly doubtful that your physician administered Botox in the area of the eyelids. If he did,  there are no studies that demonstrate that Botox interferes with the natural degradation of Juvederm.

Asaad H. Samra, MD, FACS · Answer

Botox and Juvederm can be used together without concern. In fact, in some cases it is preferable to use Botox to relax the muscle to prolong the volume effect from Juvederm. If Vitrase, an enzyme to dissolve Juvederm or Retylane for that matter, is needed to get rid of unwanted filler, its use will not affect the Botox effect.

Jo Herzog, MD · Answer

I agree with others. No problem dissolving the juvederm and next time would use restylane in area instead.

Steven Wallach, MD · Answer

Botox should not have any impact on fillers or vice a versa.  They work in different ways and for different reasons.

Purvisha Patel, MD · Answer

Vitrase, or hyaluronidase will help dissolve the Juvederm. The neurotoxin injected into the muscle, in theory could decrease the lymphatic drainage of the eye area, but you do not have enough neurotoxin injected into the muscles to effect your treatment.

Does Botox Interfere with Juvederm Dissolving?

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