Why won't Juvederm Ultra plus XC dissolve? (photos)

 Thank you for your question, and sorry to hear that you did not have a good experience.  Injecting Juvederm to achieve a soft and natural enhancement is an art. I would make sure that you know who your injector is and what experience they have. The use of Vitrase is an even more of an art than the traditional fillers, as this is done much frequently. I would definitely look for an expert injector for any future injections, including the Vitrase injections.  I would recommend a consultation with an experienced board-certified plastic surgeon or dermatologist to examine you to see whether additional dissolving is feasible.

First, let me say that I am sorry that you are having this difficulty. The good news is that fillers, such as Juvederm Ultra Plus XC are not permanent fillers and the material should ultimately be broken down and metabolized naturally, the way that natural hyaluronic acid (our own) eventually is. (This is, incidentally, the reason that I am not in favor of the use of foreign-to-the-body fillers, such as silicon, artecoll and bio-alcamid, which, if early or late-developing problems occur, cannot be easily removed from the skin--if at all). In the case of hyaluronic acid fillers, such as Juvederm, there seems to be (depending upon their individual physical and chemical properties) a hierarchy vis-a-vis their dissolvability with hyaluronidase  Products such as Voluma XC and Belotero are less easily dissolved with the enzyme; Juvederm products are intermediate in their response to being dissolved; and Restylanes are the most easily eliminated in this fashion. The seeminly excessive amount of Juvederm injected in this case, along with Juvederm's individual rate of response to hyaluronidase may explain the persistence noted here. In my experience, the upper cheek location is also generally a place where filler may persist for a somewhat longer period of time (as opposed to more mobile locations like the smile lines). Finally, since Juvederm holds on to tissue water, even as its molecules are being dissolved, this may likewise be contributing to the persistence of the cheek swelling.A second opinion by an experienced, expert board certified aesthetic physician injector might be in order. ,

Thank you for sharing your case.  I'm sorry that you have had to deal with this situation for the last year!  My first question is whether you are sure that only Juvederm was injected?  Sometimes, patients forget or don't realize that other fillers are used in combination with Juvederm.  Products like Radiesse will not respond to vitrase injections.  Obtain a copy of your medical record and consider seeking a second opinion.  In the end, you will likely need more hyaluronidase injections before considering any other treatments.  Good luck!