How soon after hyaluronidase can you get more filler? (photos)

Question

I had hyaluronidase injected this afternoon to dissolve Juvederm under the eyes that had created puffiness and tyndall effect. Seems that the enzyme has worked already but EEEEKKKK!! deep hollows/indents under my eyes. SCARY!!! May be worse because of natural HA dissolving (though I believe it will regenerate). How soon can I have a filler reinjected? And should I rather use Restylane for this area? Please someone tell me that this problem is solvable!! I feel like I look awful now! thank you

Raffy Karamanoukian, MD, FACS · Answer

Our office specializes in the removal of facial fillers, including those made of HA. Hyaluronidase can dissipate the HA filler and you will need to wait a few weeks for things to settle down before adding more filler. Best, DR. Karamanoukian Los Angeles

Parker A. Velargo, MD, FACS · Answer

Hyaluronidase should correct this issue.  If minimal to no swelling is present, additional filler can be placed 3-5 days after.  If swelling is distorting the anatomy, I would wait 2 weeks so that the subsequent injection can be as accurate as possible.  I don't use Juvederm in the tear trough.  Restylane or Belotero is my preference in this area.  Be sure your physician is an 
experienced "core" injector (facial 
plastic surgeon, plastic surgeon, dermatologist, or occuloplastic 
surgeon) because we all have a keen understanding of facial 
anatomy and the effects of injecting fillers in different
 regions of the face.   I wish you well!

Brian S. Biesman, MD · Answer

While fillers can be added in an incremental fashion it is difficult to remove them precisely.  It is not uncommon therefore to be left with relative volume deficits after hyaluronidase injection.  Should this occur, it is important for the swelling to resolve prior to reinjecting with more filler.  One to 3 days is typically sufficient depending on the amount of hyaluronic acid that needed to be removed, the anatomic location, and the amount of hyaluronidase injected.  Best of luck!

J. Jason Wendel, MD, FACS · Answer

Thank you for your
question.Wait 2-3 days before getting injected again.  Longer if you have inflammation. We recommend a low viscosity filler such as Belotero, Juvederm Ultra, or Restylane.

To be sure, 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 these
treatments.

I hope this helps.

Richard Sadove, MD · Answer

Excuse me please. I usually do not respond to these. 
I your case, I can not help myself.
You have injected hyaluronic acid under your eyes which have a risk of blindness and had a bad result leading to a need for enzyme injection( not unusual). Now as I understand you consider doing it again?
I am sorry. Plan A did not work. I would not consider Plan A again. 
My suggestion would be to see an experienced Board Certified Plastic and Reconstructive surgeon regarding your potential need for surgical treatment of lower lid fat bags and possible fat grafting if indicated. Quick fix non surgical options are often too good to be true.
Best Wishes

Todd Christopher Hobgood, MD · Answer

From a technical standpoint, the hyaluronidase that you have utilized should be completely deactivated after 48 hours. However, there is no doubt that the injections around the eye will cause some relative swelling in this area that probably should be observed for at least two weeks. You certainly don't want to inject the area before complete resolution.Restylane is the best choice for under eye correction.  Remember this is safe but off label use according to the FDA approvals.Advantages of Restylane for lower eyelid correction:A very thin needle is used for placement (or a non-penetrating cannula) therefore less bruising riskLess hydrophilicity (translation- this won't swell up over time)Less tyndall effect (a blue hue that can appear in the tear trough with injection close to the surface)

Sheryl D. Clark, MD, FAAD · Answer

Two days of waiting is sufficient. Restylane or Beletero are excellent choices and are less likely to cause the puffiness you experienced.

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

Hyaluronidase works immediately and really has had its full effect after about 24 hours. I will inject filler into someone about 48 hours after hyaluronidase. I always prefer Restylane under the eyes. "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."

How soon after hyaluronidase can you get more filler? (photos)

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