Lumps from JUVÉDERM will not go away. Is this normal? (photo)

Question

I have had many hyaluronidase injections over the past 3 months to remove the lumps created by a previous plastic surgeon. Are they any other procedures that can be used to remove the lumps and restore my cheeks back to normal???

Martin Jugenburg, MD · Answer

Lumps can be a side effect from filler injections. It can take approx a year for filler to dissolve. You can attempt to massage the area to speed up the metabolism of the product.

Michael A. Zadeh, MD, FACS · Answer

When injected in the correct area and using the correct dosage then Hyaluronidase should start to dissolve a Hyaluronic acid filler within minutes. If you still have lumps despite multiple injections of Hyaluronidase then it may be possible that you were not injected with Juvederm or any other Hyaluronic acid based filler. Rarely, after multiple injected to the same area excessive scar tissue can form and create an uneven appearance. I suggest you clarify with your original injector exactly what filler was used before you attempt any more treatments. Good luck.

Kris M. Reddy, MD, FACS · Answer

Beyond accumulation of product, you may have had a hematoma which may take a while to resolve itself. Consult in person with an experienced and expert physician injector to understand your options. An experienced injector may recommend other techniques to remove including heat.

Joseph A. Eviatar, MD, FACS · Answer

Hylenex and Vitrase are the 2 commercial forms of hyaluronidase that will completely dissolve Juvederm.  It may be that not enough product was used to dissolve it or that there is some bruising in the area.  If you've had other fillers in the area, this may be causing some of the issue.  Juvederm slowly gets absorbed by the body, although this can take several years at times, but massage often helps and skin tightening treatments such as Ulthera and Thermi smooth can melt the product as well.  Sometimes just gently massaging the area 2 times per day for 2 minutes for a month or 2 will gradually lead to improvement without further traumatizing the tissue.  You need a consultation with an injection specialist to determine the best course of treatment though.Best of luck

Yadro Ducic, MD · Answer

Really time generally will take care of it. you might want to try massage the area to see if it helps speed up the process.

Sheryl D. Clark, MD, FAAD · Answer

Is it possible that you had a hematoma after your injections? This can take longer to resolve and would not respond to hyaluronidase.  Heat would help it to go away more quickly, as might Pellevé, Thermage, or focused ultrasound.If it actuallly was Juvederm and less than 50 units of hyaluronidase was used to reduce it, your physician may want to use higher doses. i would ask if Sculptra, Radiesse, Artefill, or Silkon were used in that area.All the best! Dr. Clark

Anita Sethna, MD · Answer

Juvederm has many versions--some thicker than others. Lumps can form, but usually with massage and time, they settle easily. The concern should resolve with a quick phone call to your surgeon-confirm what type of filler you had injected first off, and if it was Juvederm, perhaps it was one of the thicker versions that lasts longer. If you can see the lump (not just feel it if you push hard) and it is bothersome, perhaps the amount of hyaluronidase was too little. You should see a difference within a few minutes of injecting the proper dose, though some surgeons are so conservative, they will only inject small doses. If after trying all that, you are still having trouble, ask your surgeon for a second opinion or recommendation to make sure you are satisfied. I am sure he or she ultimately just wants you to be pleased with your outcome.

Leyda Elizabeth Bowes, MD · Answer

Lumps from Juvederm are unusual and may be dissolved effectively with hyaluronidase injection. The fact that your lumps have persisted for three months after multiple hyaluronidase injections makes one consider the possibility of an additional filler being used, rather than just the Juvederm. Secondly, the units of hyaluronidase injected may not have been sufficient to 'melt' the hyaluronic acid in those areas.

Steven Wallach, MD · Answer

Hyaluronidase works on hyaluronic acid fillers like restylane, perlane, and juvederm. It will  not work for the other products like sculptra or radiesse.

F. Victor Rueckl, MD (in memoriam) · Answer

The only time that hyaluronidase doesn't work is when a procedure other than hyaluronic acid was done, like Radiesse, Sculptra, etc. After 3 rounds of hyaluronidase treating an area injected by Juvederm you would have seen some changes. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

Lumps from JUVÉDERM will not go away. Is this normal? (photo)

Answers (10)

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