Dissolving lip fillers. Do I need another session of hyaluronidase? (Photo)

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

First, it can take 2 weeks for the swelling from the injection process to go down, independent of the filler.

Then, injecting the hylanex reintroduces more swelling. The product breaks down within 24 hours, but it can take the tissues a week or more to actually remove the breakdown products from the tissue.

I recommend taking arnica and waiting another 2 weeks. Lip injections can vary from person to person, so sometimes it’s better to give the same person a chance to learn from experience with how you react to filler. If they have good reviews, give the injector another chance. If the reviews or other before and afters are not good, try someone else.

This is a situation that requires ONLY in person examination followed by discussions of options. Over the Real Self internet is not the place to make a final determination upon dissolving HA fillers or adding more.