Restylane injections. Large hard lumps won’t go away with Hyaluronidase. Why is it not going away? (Photo)

Question

I have multiple large lumps in top lip that has caused an unsymmetrical appearance. I’ve had 20+ treatments of Hyaluronidase and they are still there! I was told Restylane Lyft was used when my lips were injected. I seeked out a different RN on doing my Hyaluronidase injections- not the same injector that did the filler. Why is it not going away? Scar tissue maybe? It’s been 4-5 months since I’ve had the original Restylane lyft injected!

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Sheryl D. Clark, MD, FAAD · Answer

Dear HoustonTH:Have you considered seeing a board-certified dermatologist or plastic surgeon for this problem, and for filler injections? I have not seen nodules with Restylane Lyft and wonder if you were injected with something else. The rare side effect of nodules can usually be avoided by injecting small aliquots and using the appropriate filler for the area to be treated. In the rare event that they occur, injecting triamcinalone with or without 5 FU should take care of the problem.Sheryl Clark MD FAAD

Steven F. Weiner, MD · Answer

I'm sorry this has happened to you. I don't think anymore hyaluronidase injections will be useful. I would consider treating with 5FU and/or Steroid injections. If still no help, consider surgical excision. I haven't seen Lyft do this before. Are you sure you received Lyft?

Restylane injections. Large hard lumps won’t go away with Hyaluronidase. Why is it not going away? (Photo)

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