Would diluted hyaluronidase be better for very large areas for filler injected into the deep dermis layer?

Question

filler in October: Refyne, Lyft and Silk. 4 in total , I had 7 treatments with dissolver: .used 1 to 2 and 3 vials of hylenext each With only partial results. Filler still swells and I look like when I was injected first.when it swells , recently I found out from ex provider it was injected in the deep dermis and not subcutaneous ( in some area it was close to subcutaneous) Since filler is in the the whole face and probably softened by previous treatments, wouldn't diluted hyaluronidase be better?>

Raffy Karamanoukian, MD, FACS · Answer

Hylauronidase has many advantages and should be considered in patients who are unhappy with their results or in acute cases of overfilling or occlusion. Its often better to reverse filler and restart then to deal with long term edema. Filler migration and permanence is a very common problem because there are many different types of HA fillers on the market and each is specified for a specific part of the face. Use of highly cohesive fillers on thin skin may cause swelling and nodularity. If patients have filler migration or nodules, we recommend a combination approach of filler reversal with enzymes Hylenex and Hyaluronidase in different strengths to dissolve the filler. We may also need to add Kenalog to the mix in order to reduce fibrous tissue. If the filler does not dissolve, it either means the filler is not HA material or we need more enzyme. The HA reversal can be combined with other lasers and skin treatments at the same time, and it usually (usually) does not affect adjacent tissue.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anil R. Shah, MD · Answer

Hyaluronidase will have best effects for over-treated areas when applied within a couple months post-HA filler injection. Without having standardized photos to assess your areas, I would recommend that you seek in-person consultation to determine if having diluted hyaluronidase is best for you. Patients who have been over-injected often fear that all of their filler will be removed after having Hyaluronidase or that they will appear diveted and depleted. This is not necessarily true if injecting with an experienced injector who can evenly spread hyaluronidase in targeted areas. Some providers will actually dispense hyaluronidase injections in very small amounts to target certain areas without depleting all hyaluronic acid. 
I recommend that you seek in-person consultation with an experienced injector.
Best, 
Dr. Anil Shah

Kevin Tehrani, MD, FACS · Answer

Thank you for your questions. I would not recommend diluting, but trying to work with an expert injector or plastic surgeon who will inject the product correctly and in the right area. It usually does take several sessions of hyaluronidase considering you had 4 syringes of filler injected. I would continue to follow up with an experienced provider to see if you can continue to get results. Good luck!

Michele S. Green, MD · Answer

I would definitely not have the Hyaluronidase diluted to have the fillers dissolved. The deeper injections may need to have more hyaluronidase injected. It may take several times to dissolve a lot of deeper fillers.  Please consult an expert to dissolve your fillers.  Best, Dr. Green

Leonard Grossman, MD · Answer

Hyaluronidase is usually diluted with salinr so as not to administer too much of the product. The fillers that you mentioned are actually designed to be injected into the skin at any depth with complete safety. I would find out if those were really the fillers that were used on you as something does not make sense here as I have used the same fillers for over 25 years. You should also have an in-person consultation with another plastic surgeon. Good luck from New York City plastic surgery

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