What are the alternatives to hyaluronidase after already using it and have Restylane left?

Question

Had vitrase and have a little superficial Restylane left on one side of the under eye. The vitrase seemed to change the quality of my under eye skin so I do NOT want anymore inject. What alternatives do I have to making this less noticeable? Excision? Thickening skin? Any help would be great!

John Tang, MD · Answer

I like to use Venus Freeze which is a RF Device.  The heat will break up the filler but in doing so it will stimulate collagen so the skin improves.  The other plus that if you got a bruise from the previous procedures it will help hasten its removal.   Also, the Venus Freeze does not have any downtime.   For this to help reduce the filler you will need 2-4 treatments spaced 1 week apart.

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  I typically only inject Vitrase for my HA fillers.  You can try gentle massage to help break it down even more otherwise it will break down on it's own over time.  I would recommend following up with your injector to see if they have any other recommendations.

Andrew Campbell, MD · Answer

Hyaluronidase will not permanently change your skin, so the answer to your question is to use more hyaluronidase to dissolve the unwanted filler. I hope no one would ever excise an HA filler. There is absolutely no reason to do so. HA filler will get dissolved with hyaluronidase. It just may take a little more.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Trevor M. Born, MD · Answer

Dear NCG427Thank you for your question!  I am sorry that you are having difficulty .  Changes to the skin are uncommon. You can try another enzyme - or compunded enzyme  to remove the product , and RF or laser to improve the skin , possible PRPWith Warm RegardsTrevor M Born MD

Harold J. Kaplan, MD · Answer

Hello NCG.  There are no effective and practical alternatives for removing Hyaluronic acid based products without using Hyaluronidase.  Extraction or excision are never recommended because of the potential for scarring.  Hyaluronidase will not change the quality of your skin when injected, it simply works to break down the bonds that hold hyaluronic acid based gels together.  We would recommend sticking with that route vs. any other option your are considering.  Alternatively, in a few months you should be looking better without doing anything and just letting the body dissolve the product.  Best of luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your Restylane issues.  Without the use of Vitrase, Hylenex, or another Hyaluronidase the only other option is to allow the material to dissolve slowly on its own.  Hope this helps.

Brian S. Biesman, MD · Answer

Thank you very much for your question.  I am sorry having problems after injections.  If the product of concern is placed superficially, I believe the hyaluronidase is your only option.  However a very small dose of the a larger volume of saline so as to minimize the total dose administered.  I would make sure he was treated by a physician who is highly experienced in this technique.  Best of luck..

Nelson Lee Novick, MD · Answer

Although I have repeatedly encountered claims that hyaluronidase, the enzyme found in Vitrase or Hylenex, that dissolves injected hyaluronic acid filler only dissolves the filler and not natural surrounding hyaluronic acid, I personally have not found that to be true and it may be this that you are describing as a change in skin quality. To reduce this unwanted consequence, when hyaluronidase is used, it must be instilled in the smallest amount and in the lowest concentration and injected directly into the center of the unwanted filler to reduce the chance of it affecting the surrounding normal tissue. The use of a small amount of intralesional antiinflammatory, such as triamcinolone acetonide has been suggested as another treatment possibility, but this, too, can lead to surrounding tissue changes. It is for reason that I would consider the use of simple subcision accompanied by the injection of normal saline to simply break up the residual filler accumulation and make it easier for the body to naturally metabolize and eliminate it. Make sure that you are consulting with a board certified aesthetic physician Best of luck.

Monika Soni, MD · Answer

Thank you for your question! There are no effective and practical alternatives for removing Hyaluronic acid based products without using Hyaluronidase. Extraction or excision are never recommended because of the potential for scarring. Hyaluronidase will not change the quality of your skin when injected, it simply works to break down the bonds that hold hyaluronic acid based gels together.  We would recommend sticking with that route vs. any other option your are considering. Alternatively, in a few months you should be looking better without doing anything and just letting the body dissolve the product.  Best of luck!

Maha S. Shakir, MD, FACS · Answer

Thank you for the question. Sorry that you did not have a satisfing result with Restylane injection under the eyes. Hyaluronidase is the way to make it go a way. But since you had side effect from it, I recommand waiting for it to resolve on its on. Good luck.

Lake Oswego Vein and Aesthetic-LOVA

Lake Oswego Vein and Aesthetic-LOVA

What are the alternatives to hyaluronidase after already using it and have Restylane left?

Answers (17)

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