May Need Hyaluronidase: How Can I Get the BEST Injector? Touchy Issue!

may need to reduce or reverse Juvederm tear trough injections. Swelling persists at 2 weeks: I will wait one month, that's it. My injector (board certified plastic surgeon) Has never used hyaluronidase; I want to get his total assistance with resolving this, hoping he will communicate with another doc that uses hyaluronidase a lot. I know it's best if the original injector reverses it, but it seems I should get an expert at the reversal technique, and not be a test subject! Please, any suggestions?

Doctor Answers 13

Juvederm and hyaluronidase

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Most well-trained and experienced injectors (surgeon or other) know proper technique for injecting hyaluronidase - if your surgeon doesn't feel comfortable providing the treatment, do some research and find a provider who does. It's not complicated, but does need to be done with care and expertise.

Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Receiving hyaluronidase

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would certainly give your eye swelling more time before making a decision on reversal. If you are still swollen at 4-6 weeks after injection, I think hyaluronidase is a good decision because filler material in the tear trough area can last 1-2 years!

The fact that your injector is not experienced with hyaluronidase does not speak to his ability to use it appropriately. It is a relatively straight-forward procedure, although any injection and medication carries risks. If your injector is not comfortable using hyaluronidase, seeking another injector is certainly reasonable. On a practical point, having another physician inject hyaluronidase will incur an additional cost (several hundreds of dollars usually) because it is an expensive medication. If your original injector is not comfortable injecting hyaluronidase, it is reasonable to ask him to cover the cost of another physician to do it.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon

Hyaluronidase technique

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Reversing filler with hyaluronidase is generally straightforward. I have plenty of experience with it, and would be happy to speak to your doctor directly if he contacts me.

Going to another injector to dissolve the filler is really not necessary, and will likely cause you to incur additional expense and inconvenience.

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question. Hyaluronidase is injected in the area where you want to dissolve unwanted hyaluronic filler. If your doctor is comfortable with injecting it, I would stay with the same provider, as he knows you and your skin best . Whatever you decide, be sure you stay with a board certified dermatologist or plastic surgeon for the safest and best results. I hope this helps.

Using hyaluronidase to dissolve filler

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is not abnormal to still have some swelling from tear trough injections 2 weeks following your procedure. After you have reached the one month mark, I would reevaluate everything and ask the physician who performed the injections to determine whether or not he/she feels that dissolving the filler is necessary. Dissolving filler with hylauronidase takes precision and experience. If the surgeon who performed your Juvederm treatment is not comfortable with using hyaluronidase, I would recommend seeking the opinion of a physician who is comfortable with this. I hope this helps, and good luck! Please feel free to ask any additional questions. I would be happy to answer them for  you.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Eye lid swelling after Juvederm

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There maybe a few causes for the persistent swelling around your eye lids.

  1. Too soon to tell.  Its possible that you may tend to swell more than average and it may take more than two weeks for this to subside.  I would give it at least 4 weeks to make the final decision.
  2. Possible that you have very thin eye lid skin.  In these situations, less is more when it comes to Juvederm injections as it holds onto water and can therefore create a watery swollen appearance under the lids if they are thin.  If this is what happened, yes, hyaluronidase will help to remove some of the juvederm.  Other fillers such as Sculptra or fat injections maybe a better option.
  3. Possible that it was injected in the wrong place.  If juvederm is injected too superficially, it can leave a visible bump.  This would have to be treated with hyaluronidase.

Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

Hyaluronidase - finding a good injector

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I'm surprised that anyone who does a lot of filler wouldn't have hyaluronidase in their arsenal of abilities. I've fixed a lot of bad fillers from other injectors (quite frankly because in Nevada anyone can inject under a physician's license and so there are many incompetent injectors out there). Thus, it's not always necessary to have the same injector take it out. Like you said, it's more about competency - especially around the eyes.

Hyaluronidase after Juvederm

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

its very important to allow the swelling to subside to see the final result. if the final outcome is not acceptable its possible to dissolve the Juvederm with Hyaluronidase. this enzyme is best used in the hands of an experienced doctor. I would recommend you follow the advice of your plastic surgeon and seek medical advice form who ever he/she recommends

Misbah Khan MD, FAAD, FACMS
New York Dermatologic Surgeon
4.9 out of 5 stars 32 reviews

Tear Trough filler...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It's unfortunate you've had a less than ideal result in the tear trough area. If you have a good relationship with your injector, I agree it is best to stick with him or her, and allow them the opportunity to address your concerns.


Waiting a few weeks is reasonable, and possibly massaging the area (based upon instruction by your injector) will assist with reducing swelling and mobilizing some of the filler out of the area.


After having injected hyaluronidase mutliple times to "fix" overfilled lips and tear troughs by other injectors, I do not believe it takes a great amount of technical skill to achieve good results. There are many colleagues your injector could call, or papers to research, that will give him or her the appropriate amount and dilution local anesthetic if needed, to provide a satisfactory result. It is important you understand that there is no way to control the amount of dissolution of the filler--the hyaluronidase will dissolve all the filler it comes in contact with, and this may mean you need additional filler in the area in the future. Best of luck with this issue!


Anita Sethna, MD
Atlanta Facial Plastic Surgeon

How to find a "good" hyaluronidase injector

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

This is an interesting and very "touchy" issue. Someone who has a lot of experience injecting hyaluronidase, unless they are fixing other physician's mistakes, must have a lot of patients that are not happy with their results. So therefore, by definition, anyone with a lot of experience injecting hyaluronidase has had a lot of less than satisfactory results. I also don't buy into the theory that if you inject a lot you will have lots of experience with everything. I have been injecting hyaluronic acid fillers on a daily basis since they were approved by the FDA many years ago and have yet to have anyone return to the office asking to have it reversed because they were unhappy with their result. My supply of hyaluronidase remains unused in my refrigerator, but if it were necessary for me to use it I don't believe I would have a problem using it correctly.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 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.