How to tell if there is filler left in cheeks? Is there any solution to this problem? (Photo)

Question

I had 2cc of restylane-l filler in my cheeks in august of 2020. I since tried to dissolve it approximately 5 times but my one of my cheeks still looks odd when I smile (see photo). Is it possible to tell if it’s due to leftover filler? Are there any other solutions to this problem?

Nelson Lee Novick, MD · Answer

Frankly, an in-person examination or at the very least circling in the photo precisely which area still troubles you would be very helpful. If it is the slightly elevated area that needs to be flattened more, then the additional use of hyaluronidase or changing its concentration plus subcision to physically break up any residual filler might prove useful. If you are referring to any depressions around the injected area, which may represent areas depressed by the repetitive use of the hyaluronidase, these may be filled so as to smooth the area. (Despite what you may have read, hyaluronidase may indeed affect normal surrounding tissues; it in fact had been used for injection into normal tissues to facilitate the dispersion of anesthetics, etc., long before hyaluronic acid fillers were introduced.)  You would be wise to consult with a board certified aesthetic physician. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Longterm filler problems include migration, edema, and nodularity. 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

How to tell if there is filler left in cheeks? Is there any solution to this problem? (Photo)

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How to tell if there is filler left in cheeks? Is there any solution to this problem? (Photo)

Answers (2)

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Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.