Juvederm Volbella XC under eye lumps. (photo)

Question

Hello, I had tear trough injections three weeks ago. I had two immediate occurring lumps and returned to have massage and then try to dissolve with hyularonadaise. The dissolver did nothing. I do know with certainty that it was Juvederm. The actual hyularonadasie injections felt much deeper than the original injections. I am seeing the owner of the practice this week and am afraid of trying more, is it worth it or should I just wait and how long would this conceivably last?

Raffy Karamanoukian, MD, FACS · Answer

Longterm filler problems include migration, edema, and nodularity. Filler migration and permanence is a very common problem because there are many different types of HA fillers on the market and each is specified for a specific part of the face. Use of highly cohesive fillers on thin skin may cause swelling and nodularity. If patients have filler migration or nodules, we recommend a combination approach of filler reversal with enzymes Hylenex and Hyaluronidase in different strengths to dissolve the filler. We may also need to add Kenalog to the mix in order to reduce fibrous tissue. If the filler does not dissolve, it either means the filler is not HA material or we need more enzyme. The HA reversal can be combined with other lasers and skin treatments at the same time, and it usually (usually) does not affect adjacent tissue.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Payman Kosari, MD, FAAD · Answer

The hyaluronidase should be placed where the filler was injected.  If you feel like the hyaluronidase injection was deeper, it could be that it never really dissolved the filler appropriately.  Let them know this.  It should be easy to dissolve HA fillers.  Best of luck!

Jason Emer, MD · Answer

It can take a series of hyaluronidase treatments to dissolve fillers. Belotero is a good alternative for under the eyes. I recommend injections with cannulas to limit complications. See an expert. Best, Dr. Emer

Michele S. Green, MD · Answer

Unfortunately it appears that you have product that was injected too superficially and needs to be dissolved in the same area. I would definitely return to your treating physician to have the product dissolved and fix the situation for you.  Restylane and Belotero can work well for this area too.Please keep us posted. Best, Dr. Green

Anne Taylor, MD · Answer

Hello- I am sorry to see that you do have some irregular lumps of filler.. but this should be able to be dissolved-- and usually it only takes one treatment, but in your case it might take another... I would definitely would return to your doctor for advice and treatment.

Alan M. Engler, MD, FACS (retired) · Answer

Based on what you're describing, I think it does make sense to try the hyaluronidase again.  If it was truly an HA product (only HA products are reversed b hyaluronidase) then it should, if injected where the filler was placed, produce a result.  The results sometimes appear within a few hours but it does need to be injected back into the filler.  You may want to visit one or two additional board-certified doctors before proceeding with treatment if you are uncomfortable, for any reason, with the doctor who injected the fillers.  It is not an emergency so you have some time to visits doctors and get their assessments (in person); after which you'll be better able to make this decision.  I hope that this helps and good luck.  Dr. Alan Engler, Member of #RealSelf500

George Commons, MD (retired) · Answer

I agree you have several high spots of the Vobella injection.   Injection of the hyaluronidase should be where the Vobella is and I agree with you that it appears quite superficial.   Try the hyaluronidase again more superficial.   My Best,  Dr Commons

Juvederm Volbella XC under eye lumps. (photo)

Answers (7)