Can Hyaluronidase Injections Dissolve Juvederm Several Months Later?

Question

I had Juvederm injected in my laugh lines and under my eyes to fill out the hollows. It was too swollen and the doctor dissolved some of it with enzyme, but she did it unevenly, resulting in unnatural lumpiness and swelling that has still not decreased after 9 months! I am certain it is the product because I never had bags or swelling prior to this procedure. I also have lumps under my smile lines that now appear as jowls. Can these lumps still be dissolved by hyaluronidase injections?

Michael A. Persky, MD · Answer

Hi Debhon,
Sorry to hear about your complication.  You have received excellent advice from the docs here on RealSelf.com.  Your case further emphasizes the admonition that it is crucial to choose an injecting physician most carefully, especially around the eye lid area. 
Patients should seek our physicians who are experienced and board certified in one of the cosmetically oreinted specialities such as facial plastic surgery, plastic surgery, ENT, opthalmoplastic surgery, or dermatology.
Good luck with rapid resolution of your lumpiness under your eyelid.
Dr. P

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anil R. Shah, MD · Answer

It is more difficult to dissolve HA's months later since some collagen is often incorporated into the filler.  While this is a good thing generally, it can make dissolving filler more difficult, particularly much later.  Best Dr. Anil Shah

Young R. Cho, MD, PhD · Answer

Thank you for your question and for sharing your photo.  Sorry to hear that you're experience with injectables has not been ideal.  I would recommend that you visit an experienced injector who is a plastic surgeon or dermatologist who has worked with Hyaluronidase in their practice.  I have used Hyaluronidase in this region even years after an injection that has lingered around with some success.

Debra M. Kroll, MD · Answer

Yes--great news.  Hyaluronidase can help even months later.  Find an experienced aesthetic physician (oculoplastic, facial plastic/plastic surgeon, dermatology) that has a lot of experience with fillers and hyaluronidase.  Good luck.

Mark Berkowitz, MD · Answer

I am sorry to learn of the difficulty that you are experiencing. Perlane, Juvederm, Restylane or Elevess are all Hyaluronic Acids (HA).   The beauty of them is that  they are soft and work well to fill in lines and wrinkles around the face. 
Side effects from these fillers and dissatisfaction is rare.  When  these occasions do occur the wonderful thing about this group  of fillers is that we can offer Wydase or Hyaluronidase to reduce or dissolve them. 
As an Ocular Plastic surgeon, in the suburbs of Detroit, I utlize Wydase all of the time as part of my freezing solution for eyelid surgery.  Side effects from this substance are rare with the most common being an allergic reaction (which I personally have never encountered with over 3000 procedures, Knock wood:))   
I would ask you to return to your trusted physician to see if he would  use the hyaluronidase to reduce this lower  eyelid lump.  You cauld also consult an Ocular Plastic Surgeon who could surgically remove the filler.

Charles Cheng, MD · Answer

...if the lump or swelling is purely hyaluronic acid filler.  Lumps can be many things.
We have treated many patients with HA lumps over the past twenty years.
Very commonly, we see patients seeking treatment of HA lumps that respond very well to hyaluronidase even years after the original injection.
Granuloma cannot be diagnosed by looking at a photo.  It is actually a diagnosis by histology (i.e. biopsy).  I would certainly try hyaluronidase first before injecting 5FU.
Again, the best advice would be from an experienced filler injector that can assess your problem in person with a proper history and physical examination.

Steven F. Weiner, MD · Answer

First off, Juvederm shouldn't be used around the eyes. It causes swelling in this area, sometimes years later. It is sometimes required to get multiple treatments to dissolve filler, particularly Juvederm. Also, all hyaluronidase is not the same. I prefer to use Hylenex. Compounded hyaluronidase is supposedly less active then the commercial brands. Sometimes, 3-4 treatments are needed to dissolve filler.

Jennifer Janiga, MD, FAAD · Answer

The short answer to your question is yes, you can have Hyaluronic Acid fillers like Juvederm, Voluma, Volbella, and Restylane injected months later and it will help if there is filler there.

Regina M. Fearmonti, MD · Answer

So sorry that this happened to you! Hyaluronidase can be used to dissolve HA-based injectables but is not without risk and side effects.  With your delayed presentation, however, I would recommend possible biopsy to rule out a granuloma (an inflammatory nodule).  That is treated best with steroid injections and 5 FU. Ask your doctor about these things. Hope that helps!