How Can I Find a Doctor Willing to Treat Me with Hyaluronidase when the Injecting Doctor Won't Use the Dissolver?

Treating your problem with hyaluronidase should be relatively straight forward, but it does depend where (at what the depth) the Juvéderm was injected. If Juvéderm was placed at more than one level, it will important to inject the hyaluronidase in all those areas to experience complete resolution. A physician who is not willing to use hyaluronidase should not be injecting Juvéderm in the first place. And I am a bit surprised that another physician is not willing to help you.
When hyaluronic acid (HA) is injected superficially beneath the skin, a resulting bluish discoloration called the Tyndall Effect occurs. The Tyndall Effect results when light scattering particles are dispersed or suspended in a light-transmitting medium. Light passes through the thin skin, into the hyaluronic acid gel. The longer wavelengths are more transmitted, while the shorter wavelengths are more scattered and reflected back – thus accounting for the blue coloration. This phenomenon is not unique to Juvéderm and can happen with many other HA gel fillers. Belotero is reported to have less Tyndall Effect than other HA fillers, so it may be a preferred product when performing very superficial injections.

Juvéderm, however, in comparison to other HA gel fillers, does exhibit more swelling when used around the eye. This can occur and persist immediately after injection, or it can even occur in a more delayed fashion. Restylane does not exhibit the same degree of swelling so it is a preferred product for this area. This swelling I am referring to commonly occurs after treatment of the tear trough. (I don’t know if this was an area you had treated). When treating superficial lines and creases in the lateral canthal area (crow’s feet), there is a risk that many of the gel filler products may result in swelling and irregularity if too much product is injected, and done so inconsistently.

Since many of the lines and wrinkles in the crow’s feet are caused by muscle contraction, BOTOX Cosmetic should be the first line treatment in this location. BOTOX works well (in the absence of skin laxity) to reduce crow’s feet wrinkles caused by contraction of the orbicularis oculi muscle. If additional improvement is needed then HA filler injections could be considered; they should be performed by an experienced injector. Overall, I find the use of HA fillers to improve crow’s feet lines much less effective than when the same filler is used in other areas of the face. Laser resurfacing is another option for crow’s feet lines, and is much more effective long term.

The American Society for Aesthetic Plastic Surgery website and the Juvéderm website should be resources you can use to find a physician who is experienced in these treatments.

With respect to the BOTOX cosmetic treatment you also had, this appears to be suboptimal as well. I suspect too much BOTOX was placed in your forehead and has produced brow ptosis (brow droop). Your frown lines appear to be under treated, and your crow’s feet could be slightly improved. Properly treating your frown lines and touching-up your crow’s feet should provide some balance and improve the brow ptosis that has resulted.

Your experience demonstrates that your physician is not experienced with either fillers or BOTOX. And it is a reminder that patients should seek an experienced injector when considering these treatments…the results are much better and the complications less frequent.

Best wishes, Ken Dembny

   The hyaluronidase can be injected until all of the product is dissolved or until the desired effect is achieved. 

Unfortunately, you need to post updated photos. It is very hard to determine if more hyaluronidase is the answer.  You have had some injected already. Maybe there are other issues to consider now. These are the same photos you have had posted for some time now and the yellow bruising is still visible in those photos.  I'm sure you have improved some by now, so giving us some new photos would be more helpful.

I would recommend going to the Juvederm website and finding the top listed physicians in your area.  Select a cosmetic specialist (cosmetic dermatologist or plastic surgeon who personally injects a lot of filler) towards the top of the list (doctors are listed in order of how much Juvederm they purchase from Allergan) and call their offices to find out if they use Hyaluronidase.  In my office we often correct other clinics mistakes plus we like to have Hyaluronidase available just in case we ever have a problem, but Hyaluronidase has a short expiration date and is expensive, so many offices do not have it on hand.

If you had a complication from poor injection of a filler, your injector should treat you with hyaluronidase.  It doesn't make sense that he/she will not, so there must be more to this story. Perhaps, they feel that the problem is not the filler, so hyaluronidase will not help. Or maybe they are not a plastic surgeon or dermatologist and should not have been injecting you to begin with.  If hyaluronidase is indicated and your injector will not do it, he/she should personally recommend a physician that will. It is not surprising that no doctor that you called is willing to treat you and get involved in potential litigation.