Dissolving a Lump from Hyaluronic Acid Injection?

Question

I had HA injected(Perlane/Juvederm/Restylane) in 2010 to correct a crooked nose(the top of the implant was tilted to the right). Oddly the HA injected on the left side of my bridge did not dissolve completely on its own. I just had a 2nd nose job in 2013 using goretex. However after the correction I noticed from the left view the top of the bridge looks too tall. Is it possible to dissolve HA injected 3yrs ago? will injecting HA-DASE cause infection since I have a goretex implant underneth? thx

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

Michael I. Echavez, MD · Answer

Hyaluronic acid fillers, such as Perlane, Juvederm, and Restylane, would not last 3 years, so they would not be the cause of the current issue with your nose. I would return to your surgeon to be evaluated so that the cause of your problem can be discerned. And just to answer your last question, it would not be a problem to use hyaluronidase near a goretex implant.

Stephen Weber MD, FACS · Answer

I agree with Dr. Echavez that the hyaluronic acid filler that was injected three years ago is no longer present. Hyaluronidase likely will not improve the lump that you see. I recommend that you followup with your plastic surgeon to determine their toughts and come up with a treatment plan. I hope this information is helpful.

	Stephen Weber MD, FACS

F. Victor Rueckl, MD (in memoriam) · Answer

While fillers in areas that do not move much, like the nose, can tend to last longer than fillers done in the lips, I would be hard pressed to believe you have any there left after 3 years. I would think there is likely to be scar tissue there instead that is causing your issue. Consult with your surgeon, but I don't think hyaluronidase will do a darned thing because I don't think there is any filler left there.

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