Can hyaluronidase be injected to try and remove filler if the Filler is not Hyaluronic Acid?

Question

Hi, I had some injections done to my buttocks region about a year ago. I am not exactly sure what was injected but the injector said it was hyaluronic acid. I am not very happy with the result and would like to have this stuff removed. A physician recommended hyloranidase but he will not inject it unless he knows what the product really it. Is there any harm to have hyaluronidase injected if the product in my buttocks is not hyaluronic acid? What is the overdose amount for hyaluronidase?

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.Hyaluronidase is used to dissolve only hyaluronic acid (HA) base fillers such as Juvederm, Perlane and Restylane. Contact the provider who injected you to find out exactly what kind of product was used. It is not recommended to inject using hyaluronidase unless you know a HA based filler was used. To be sure what is the best option for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.I hope this helps.

Jerome Edelstein, MD · Answer

It is not recommended to inject your buttocks with hyaluronidase if you do not know what the original product is. You should go back to your original injector and confirm what the material was before proceeding with a treatment to resolve your concern. However, if it was indeed hyaluronic acid filler, then your body will naturally break it down so if you wait eventually the result will go away.

Edward J. Gross, MD · Answer

Hyaluronidase works to break down hyaluronic acid
based fillers. If it is not a hyaluronic acid filler, such as Radiesse, then
hyaluronidase will not be effective in removing the product. Unfortunately, the
only way to get rid of any non-hyaluronic acid filler is to wait until your
body has completely metabolized and dissolved the product.

Sheryl D. Clark, MD, FAAD · Answer

Injecting this enzyme to areas where HA has not been injected can result in depressions in the skin and is not advisable. Why are you not happy? Are you having lumps or redness?  If so, it might be highly advisable to have a biopsy to see what filler was used and what kind of reaction is occurring.  Patients gave been injected in this area with adulterated filler, even oils that have no business being injected anywhere in the body, and have developed TB of the skin and other ptoblems.  Please see a board-certified detmstologist or plastic surgeon for advice.

Michele S. Green, MD · Answer

Hyaluronidase is only meant to break down hyaluronic-acid based fillers.  You should consult with a board certified dermatologist to determine what the best method for removing the specific type of filler you had injected.

Benjamin Barankin, MD, FRCPC · Answer

Firstly, hyaluronidase is an enzyme that only breaks down hyaluronic-acid based fillers such as juvederm, restylane, perlane, and belotero. There are lesser known HA products as well including Teosyal and Revanesse for which this would work. For all other fillers, you'll have to wait for them to naturally break down, or have them cut out, or your dermatologist can sometimes break up the filler with a needle and injections of saline or a mixture of a few things (e.g. saline, hyaluronidase, and kenalog). Best to speak with a dermatologist about your best options. In the future, ensure that only a dermatologist injects you, and that you know exactly what is being used.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

Hyaluronic ask can effectively dissolve hyaluronic acid. If you have had injections with other types of fillers, there is no guarantee that the hyaluronidase will have much effect.

Stephen Weber MD, FACS · Answer

The concern is that hyaluronidase will only break down hyaluronic acid. If injected directly into deposits of hyaluronic acid at a reasonable dose, there is very little risk of removing your native hyaluronic acid. If alot of hyaluronidase is injected into an area that only contains your natural hyaluronic acid (no hyaluronic acid based filler) then there is a risk of creating a hollow or contour deformity. The same thing can happen when excess hyaluronidase is used in the face - it can remove some of your natural hyaluronic acid and create a hollow area. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

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

Here's the problem: hyaluronidase only works to dissolve hyaluronic acid. If you inject it where there is no hyaluronic acid (i.e. into a filler a year old that is silicone, etc.), the hyaluronidase will then work to dissolve your natural hyaluronic acid in that area. It's best not to inject it if you don't know if the filler is hyaluronic acid or not. The only thing I could say is that you could have your physician try a very small area/amount and see if it works. But if it's been a year and if it's in your buttocks, the likelihood of it being hyaluronic acid is negligible. I'd think it's almost certain to be silicone. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

Can hyaluronidase be injected to try and remove filler if the Filler is not Hyaluronic Acid?

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