Is there anyway to break down 1 ml of Voluma in both cheeks without hyaluronidase?

First, I am very sorry you have been having these negative experiences, first with your under eye filler and now with the cheek volumizing filler. Hindsight is twenty-twenty, but going forward and for other readers of this column, it emphasizes the importance of seeking treatment and consultation by board certified aesthetic physicians with special expertise and experience in advanced techniques of nonsurgical facial sculpting, contouring and shaping via the use of injectable volumizing and filling materials, so as to minimize the need for corrections, such as you have undergone. Although hyaluronidase remains the most efficient means for dissolving unwanted deposits of hyaluronic acid fillers, there are certain other techniques that I have successfully used to speed the clearance of hyaluronic acid filler, which, in the case of Voluma (a very robust volumizing filler), may take anywhere from six months to two years to be naturally metabolized away. Subcision accompanied by the intralesional injection of normal saline can help break up the bulk of the Voluma and dilute it in order to speed its natural clearance. Hope this helps. Best of luck, and remember, rather than giving up entirely on injectable fillers, in the future, make sure that you see an expert aesthetic physician.

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

Hello Panabella.  Short of surgical removal and Hyaluronidase, we know of no other options to get rid of Voluma.  It will normally take 6-12 months for it to break down on it's own.  Hyaluronidase does not break down natural collagen so you would be safe using this technique again.  Best of luck.

panabella77I am sorry you are having this issue from Voluma. The pro and con for this excellent filler is that it can last for up to two years! However, Hyaluronidase, expertly injected into areas of issue, should address your needs. However, this process needs to be done in stages, slowly, to melt away the filler material in the most advantageous way. Consult with a board-certified plastic surgeon or dermatologist in our area to explore the best options for you. Good luck.

I am not aware of any medication that can break down Voluma, other than hyaluronidase.  Results from Voluma can last 1-2 years.  

The changes from .5 cc of Voluma will be drastic and I wonder if there is another issue. Please send pictures. There will be no damage from hyaluronidase to your normal tissue. 

You can try using Ultherapy deep transducer if it’s in the cheek . The heat from the ultrasound can have an effect on the voluma to dissolve it quicker . You may need 2 rounds but it’s worth a try just to have the treatment over the area it was placed 

Voluma lasts up to 2 years. In my experience it starts degrading much sooner. I’m not aware of any other product that can breakdown ha fillers of which voluma is a part of. 

It's unfortunate that you've had a bad experience with fillers such as Voluma. Voluma can be broken down differently in every person. In some people it can be broken down in as little as six months and in others as many as two years. The closer to the eye the volume is injected the longer it can last and in some cases even indefinitely. This is the reason why I recommend not injecting any hyaluronic acid fillers close to the lower eyelid. I would recommend that you see a plastic surgeon who can evaluate you and advise you what can be done to bring the proportions back to your face without having to necessarily dissolve the voluma. I hope this helps and good luck from New York City plastic surgery

According to the Allergan studies on Voluma, this highly cross linked hyaluronic acid dermal filler lasts “up to 2 years”. In my experience, this depends on the patient’s personal metabolism as well as upon where it is injected on the face. More highly mobile areas metabolize more quickly.
Regarding hyaluronidase, this enzyme will breakdown different hyaluronic acid (HA)  fillers  differently, depending on the strength of the cross linking of the product. Synthetically produced (not naturally occurring) hyaluronic acid is chemical cross linked to improve its longevity.  The longer the product lasts on average, the more highly cross linked the product. And more highly cross linked products require more hyaluronidase to break down. Point being if you have multiple types of fillers in your face, the hyaluronidase enzyme will break down some of the HA fillers more easily than others.  
Prior to HA fillers, we primarily used “collagen”, early on bovine collagen and eventually DNA recombinant type. Collagen wouldn’t “melt” the same way HAs do with hyaluronidase. If someone had collagen that they didn’t like, I would remove it with a manually expressing with a larger gauge needle, So you have three options: 1. Wait it out (up to two years)  2. hyaluronidase 3. Manual removal 
Good Luck to you! Hopefully you can find a trusted injector that can help you through this process.