Subcision and Too much filler. What to do next?

Hello,Without a photo, we are relying on your description.  Restylane dissolves or debulks easily with hyaluronidase, but only you can decide if the area of concern warrants your having this option.  There is always a risk vs benefit scenario with any decision.  Meaning, you don't wan't to have the hyaluronidase remove more than what you anticipated.  However, if you do not treat the area, your skin would not be harmed or stretched out if you are dealing with a small amount as you suggested.  

Since 3 weeks have passed, you can choose to get the product dissolved with hyaluronidase and start over. Best H Karamanoukian MD FACS

Thank you for your question.  If you are not happy with the result then you may want to visit your injector for full evaluation.  Hyaluronidase can be injected to concerned area to dissolve the excess filler by your injector.  Best luck to you.

If you've had too much filler injected (eg, into an acne scar), and do not like the appearance, I do recommend asking your physician to dissolve the filler using hyaluronidase.  This is an easy and effective way to remove the excess filler.  Otherwise, it would take months for the Restylane to be broken down.

Subcision and leaving filler underneath would be a way to treat these kind of scars. Re-attachment of scar tissue is reduced when the Restylane will act as an separator for at least four weeks.  After that you might want to resolve the surplus. When the scars are characterized by weak spots injection in the skin (instead of under) of Restylane is an option to further improve the results.

Time frame of 3-4 days, massage as hard as possible with Vaseline 2-3 times a day. If your dermatologist did the procedure correctly, with subcsion there will be multiple tunnels under your skin, allowing over correction to settle (within reason), if way too much filler was placed- yes, Hylase would be good. Wait 2-3 weeks before making any hasty decisions. 



Subcsion was first reported in 1995. Since then this technique has taken many pathways. Most dermatologist and plastics still perform the old method- using sideways motion to break scars down. In the original papers this took 6-10 sessions using a needle. This still can be effective, but its OUTDATED. Since then other methods have evolved including-



The use of other size needles
The use of NOKOR or cutting needles
The use of cannula techniques


Of all these techniques, cannula stands out. The most recent paper this year shows that it has the best rate of scar breakdown with much less side effects than with NOKOR. Namely less bruising and ‘lumps’ from bleeding. 



The results of subcision is extremely variable and will depend on the technique and experience of your Plastics or Dermatologist. Ensure they can perform all techniques competently. This is especially important with dermal fillers (or fat transfer). If one subcises a depressed scar and find it has NOT got significant tethering, a filler is needed. In this situation filler or fat is needed to elevate the scar. Subcision is my preferred method for scar revision, as I can feel how many scars I am breaking with my 3 level cannula technique. This is now considered the Gold Standard in subcsion as reviewed by peer papers. All other modalities including lasers, energy devices and peels are considered ‘instruments’ in the way I practice acne scar revision. Remember treat the scar type with a method, and you will achieve the desired outcomes. Subcsion releases and remodels acne scarring from underneath. Needless to say this just a method, the results you will achieve is 90% dependent on the skill sets of your Plastic surgeon or Dermatologist.  



All the best, Dr Davin Lim 

Acne Scar Specialist. Brisbane. Australia.