Re-injecting Filler or Botox After Hyaluronidase?

Question

I had Juvederm injected into my tear trough area. The results were horrible, so after a month, my doctor injected the Hyaluronidase to break it down. How long do I have to wait to have Restylane or Botox injected in same area? The Juvederm appears to be gone. I have always used Restylane with exellent results, but I decided to try something different.

Richard Baxter, MD · Answer

The differences between Restylane and Juvederm are subtle, so I would not necessarily attribute the problem you had with the choice of filler. You could definitely try Restylane to see if it does any better, and if not the hyaluronidase would still work. On the other hand, a different filler may end up working better, but only the HA fillers (Restylane, Juvederm) can be quickly reversed. I do agree that about 3 months is a minimum waiting period before doing more.

David Shafer, MD, FACS · Answer

While you likely only need to wait a few days to a week before re-injection, why hurry. You need to be very careful when having injections around your eyes - especially repeat injections. These tissues are very thin and fragile. If you develop scar tissue or tissue reactions, you may not be able to resolve these problems so easily. Good luck.

Behrooz Torkian, MD · Answer

Curiosity,
You have heard many different answers to this question, so far. Remember, there is probably no real "right" answer.
The effects of hyaluronidase are rather quick. The substance also happens to absorb quickly. Thus, you can re-treat the area a few days after the hyaluronidase treatment.
I have preformed under-eye filler injections with both Juvederm, and Restylane. In my patients, I have noticed a definite difference between Juvederm and Restylane.  Restylane-injected patients have had far less swelling, and less clumping of the product in this area. I have also noticed very similar longevity between the two products. I have heard similar observations from many other doctors.
I hope this helps.

Kenneth D. Steinsapir, MD · Answer

Dear Curiosity
As I have indicated in other post on RealSelf, for a number of reasons, I am not a big Juvederm fan for the undereye area.  For this area, I get the best results with Restylane.
The effects of hyaluronidase are pretty immediate.  One sees perhaps 50% of the treatment effects almost immediately after the injection but there is some further deflation of the filling effects in the next few days.  I would have no qualms about retreating this area with Restylane a week after the hyaluronidase treatment.
For perspective, I am a double gold Restylane account and the largest user of Restylane in the under eye area in Los Angeles.  My personal feeling is that there is almost nothing that can't be accomplished with enough Restylane and that this approach is much more predictable than surgery for most people.  The big exception is in individuals with very thin eyelids.  Still treatment for these individuals can be very good and an excellent alternative to lower eyelid or midface surgery.  One must understand where the midface volume is needed or you get the very funky "new new face" (see  look being sported by a number of actresses.  Honestly an cheek filled to low is a horrible look.  Natural should be the goal.

Brent Moelleken, MD · Answer

It is best to allow a bit of time to transpire, to allow all inflammation to diminish.  This would probably be in the order of three months in my opinion.  It is best to get a very accurate and precise picture of the anatomy before injecting any more filler
Juvederm seems to be associated with more problems in the periorbital area, particularly with swelling, than Restylane.

Theda C. Kontis, MD · Answer

Unfortunately the tear trough is a very difficult area to treat, and occasionally lumps do form. Luckily, we have a filler eraser called hyaluronidase. I find that the hyaluronidase literally works overnight to break down the Juvederm. I re-treat patients about 2 weeks following hyaluronidase injection.

Steven Wallach, MD · Answer

First, you didn't mention how long ago that you had the hyaluronidase injected. I would wait a few weeks for the filler.  I do not recommend Botox to the tear trough it will not do anything.

Bryan K. Chen, MD · Answer

I would wait 2-3 months before considering Restylane injections into the tear trough area.  If you currently have no more swelling or inflammation from the previous Juvederm, Botox should not be a problem at this time.
Good luck.

Marc Cohen, MD (retired) · Answer

Hyaluronidase dissolves Juvederm quickly and also spreads through the tissues and is gone very quickly.
It would certainly be fine to get more injections of filler or Botox a day after the Hyaluronidase treatment. The only issue is that you should wait if there is still some residual swelling. Botox can reduce the pumping action of the eyelid muscles. This movement helps your body clear away the fluid from swelling. Restylane injections also can cause swelling and that is more likely to happen if your eyelids are already swollen. So, it is better to wait until your eyelids return to normal.
Hope this is helpful.

Re-injecting Filler or Botox After Hyaluronidase?

Answers (9)

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