Can I get hyaluronidase in an area on my face that I think old filler migrated to?

I am a Beverly Hills based oculoplastic surgeon. I wrote one of the earliest papers on treating under eye circles with hyaluronic acid fillers. I do a lot of facial and periocular fillers. I also do a lot of removal of old fillers. There is a lot of misinformation out there. Do filler migrate? Of course they do. Some are much more prone to this than others but given enough time, there will be migration. The more runny fillers like Juvederm and Belotero are the most prone to this. Fillers like Restylane and Restylane Lyft are less prone to drift but it happens. One does not need to do imaging on a face to see where the filler is. It is sadly much too obvious. However, I do have colleagues who despite extensive training really don't understand faces and what happens to these fillers. Under eye and cheek bone fillers migrate down the face as low as the jowl. Likely these products never actually go away due to cross linking unless they are broken down with a big enough does of hyaluronidase. Hyaluronidase does not break down fillers like Radiuses, Sculptra, or grafted fat. But it does a magnificent job of breaking down hyaluronic acid filler. It is usually visually obvious where the filler is. Imaging is academically interesting but not at all necessary for the removal of these fillers. The critical thing is to have enough enzyme to adequately break down the filler. Allergies to the enzyme are very uncommon so testing prior to injection is not warranted. The enzyme really only affects man made hyaluronic acid filler. The hyaluronic acid filler made by our body is likely temporarily affected. This naturally make material is repidly replaced. The claims that enzyme wrecks the skin are generally caused by a poorly done, under dosed enzyme treatment. What is hyaluronic acid filler is removed. Other fillers and your natural tissue are unaffected. That is why one does not need to locate every single molecule of filler to perform an amazing enzyme service. How good are these treatments? It is like getting an enzyme face lift. Women holding old filler often look 10-15 years younger within minutes of the service. Please also read my attached blog and view the attached video.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It sounds like you're dealing with some frustrating concerns about your cheek fillers. Here’s some information that may help clarify your situation. To determine if the filler is causing the nasolabial fold issue, a consultation with a qualified injector is essential. During the consultation, your facial structure and the distribution of the filler will be assessed, often through visual examination and palpation. In regards to dissolving, yes, hyaluronidase can be injected into the area if it’s determined that filler migration is contributing to the appearance of your nasolabial fold. This enzyme breaks down hyaluronic acid fillers and can help restore balance to your facial features. If hyaluronidase is injected into an area without filler, it generally won’t cause harm, but it won’t have any effect either. It specifically targets hyaluronic acid, so if there's no filler present, the enzyme will not produce any noticeable changes. In regards to imaging techniques, while there isn’t a standard imaging technique specifically for locating filler, some practitioners may use ultrasound or advanced imaging technologies to assess the depth and placement of fillers. These methods can help visualize areas where filler may still be present. I hope this helps and best of luck!

The term filler migration is an excuse that most doctors use to explain a poor outcome. There is only one area where filler migration can occur on the face and that’s in the lower eyelid. In that area, the muscle around the eye is in the shape of sphincter and it can squeeze the gelatinous hyaluronic acid out of its place. In most people. You should not see any kind of immigration. But if you do believe so then I would recommend that your doctor order you an MRI of the face. Eye on the other hand I’m pretty confident that migration is not an issue. I hope this helps and good luck from Leonard Grossman, M.D., organic Plastic Surgery.