I had two rounds of Vitrase to correct Juvederm XC. Now I have severe indentations that I did not have pre-injection. (photos)

Thanks everyone for the earlier answers. About a month ago I was injected with voluma and what I thought was restalyne. Both were supposed to go in mid cheek but it turned out that I was injected with juvederm XC, not restalyne and it all migrated to my tear troughs. Following the advice I got here, I had two rounds of Vitrase. The ridges are gone but now I have severe indentations that I did not have pre-injection. I'm concerned about doing more to my eyes. Advice?

Doctor Answers 8

Indentations after Vitrase

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Hi Kelise. From your photos it looks like the Vitrase did its job and dissolved away the filler. What you are left with is the loss of volume underneath your eyes that you had before any filler was put in. If there is still filler in your cheeks it may make the appearance of your tear troughs worse than what you though previously. Personally, I would not do anything in the way of volume correction at this time. I would give your tissues time to heal from the repeated injections. In a month or so you can then get fillers done again. I would consider a new injector with more experience this time. Best Wishes.

Sherman Oaks General Surgeon
5.0 out of 5 stars 10 reviews

Vitrase Results

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I suggest getting a second opinion and all of your previous records and bring them to the new physician.  Also, if you have a photo of what you looked like prior to any fillers or at least prior to the Voluma/Juvederm that would be helpful.  I am not seeing "indentations" in these photos, just a normal orbital rim/tear trough, maybe some slight swelling.  I wish you the best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Indentations after Vitrase

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It looks like the Vitrase dissolved the filler and now there are some contour changes due to filler that still exists elsewhere.  It is difficult to predict exactly how much filler the Vitrase will dissolve with each treatment however it appears that you might be able to have it smoothed out with additional filler (hard to be sure from the photographs).  I prefer Restylane and I add 0.2 cc of lidocaine to the syringe to make it a little finer for a very smooth effect.  I rarely get bumps with this technique but it may be that more dissolving needs to be done first.  Belatero is another option but I find it is not long lasting (6 months) whereas with Restylane I've had patients retain the correction for up to 2 years or longer.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

Overcorrection, then indentations after Vitrase

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Vitrase will not dissolve native hyaluronic acid unless very large doses are used.

One might consider a filler that spreads well in this area, Beletero.

Sheryl D. Clark, MD
New York Dermatologist
4.7 out of 5 stars 10 reviews


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The Vitrase seemed to do the trick. You will need to wait a bit to see how things settle, and then go to someone who does a lot of filler. I prefer dilute restylane in the tear trough to give the softest results.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Facial fillers

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Fillers can commonly migrate beyond the injection site.  The area of your concern is close to a specific group of facial muscles that are close to the eye (the levator labii muscles).  When fillers are injected near this area, these muscles can be pushed closer to the surface and become more pronounced. This should improve with time. Regarding the Vitrase, I agree with Dr. Kaplan. Good luck and all the best!

Jerome Obed, DO, FAOCD
Fort Lauderdale Dermatologist

Vitrase Injections to Reverse Juvederm

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Hi Kelise.  Vitrase injections do not have any effect on the skin other than to dissolve the hyaluronic acid based product that exists in the same location.  If it appears that you have an indentation after the injections, it is because the product that was filling this area is gone and needs to be replaced to address that concern.  

To see photos of Orange County, CA patients before and after ear trough injections with Restylane, click on the link below.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

I had two rounds of Vitrase to correct Juvederm XC. Now I have severe indentations that I did not have pre-injection.

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Appears as over injected Vitrase as my guess. You probably needed only 1 session. I always wait 3 weeks between Vitrase injections and use half amounts recommended. Not you need 3 to 6 months healing than consider Belotero-Balance injections to tear troughs or fat nano grafts or nothing... 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.