Hyaluronidase Not Working After 3 Tries Under Eyes

Question

I've had hyaluronidase 3 times to remove dermal fillers I had injected under the eyes, It still has not removed it all. I'm really down and off work as this is depressing me so much. I cry every night. I just don't know what else to do now as I'm left thinking I'm going to be left looking like this for months on end. It's coming up to 5 weeks now. The dermal filler used was varioderm, can you please help anyway, many thanks.

Brent Moelleken, MD · Answer

Hopefully you did receive a hyaluronic acid and not some semipermanent or permanent filler.  Unfortunately this is a frequent scenario.  We only ascertain that it was not hyaluronic acid after the fact when we surgically have to remove the offending lumps only to find the characteristic pathologic signs of silicone or Artefill.
The new crosslinking for Varioform has not been completely studied but there is no intrinsic reason to suspect hyaluronidase shouldn't accelerate the removal of it.
Your doctor should have medical records with lot numbers that he or she could send to you to confirm the nature of the injected substance.
If the lumps persist long term, you may be a candidate for surgical removal.  It is rare but possible that the body can form a granulomatous reaction around the filler, especially if large volumes are used.  Remember, filler has no blood supply and if placed in large quantities has no natural defenses.

Jon E. Mendelsohn, MD, FACS · Answer

This is one of the reasons we like the hyaluronic acid fillers - they can be reversed. I would agree with the other doctors here. First I would confirm that this is in fact the type of filler that was used. If so, then I would consider more injections to dissolve it. I have had one case with Juvederm where the filler was placed in the posteptal region and I too have injected the patient several times and it it getting better but is disconcerting for both me and our patient. As long as it is an Hyaluronic acid, it will improve despite intervention.

Raffy Karamanoukian, MD, FACS · Answer

Expertise in injecting facial fillers is equally as important as being able to correct complications associated with facial fillers.  Hyaluronidase works on a specific class of fillers containing hyaluronic acid.  The enzyme destroys the hyaluronic acid filler and restores the original volume of the facial area.
In some cases, the dermal filler may not be made of hyaluronic acid and thus does not respond to the hyaluronidase filler.  Also, an inflammatory, granulomatous, or scar component may have arisen that is unresponsive to the hyaluronidase.
In these cases, it is important to determine the exact component of the filler or reaction that is causing you complications.  If it is granulomatous or scar related, hyaluronidase will not correct the problem.
Consider consultation with an expert focused on treating complications of facial fillers. Our office is a tertiary referral center for facial fillers and their inherent complications.

Steven Wallach, MD · Answer

Hyaluronidase should work on varioderm if that is what was injected. If it was one of the other fillers like radiesse, sculptra, fat, etc.. it will not work.

Chris Thiagarajah, MD · Answer

You may need some more injections. The eyelid area can also have residual swelling that may take some time to resolve. Varioderm is highly cross linked and may not dissolve as easily though  it should dissolve theoretically.

Hyaluronidase Not Working After 3 Tries Under Eyes

Answers (7)

Answer: Hyaluronidase andf filler resorption

Answer: Hyaluronidase andf filler resorption

Answer: Varioderm and hyaluronic acid

Answer: Varioderm and hyaluronic acid

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Hyaluronidase Not Working After 3 Tries Under Eyes

Answers (7)

Answer: Hyaluronidase andf filler resorption

Answer: Hyaluronidase andf filler resorption

Answer: Varioderm and hyaluronic acid

Answer: Varioderm and hyaluronic acid

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Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.