Should hyaluronidase be used diluted with saline or undiluted to remove stubborn Voluma/Vollure over large area?

Question

i received 2 cc vollure in july all over the face. original injector got no results with 200-300 units undilued vitrase/ hylenex. two injectors used 400 unit and 100 units with a little (very little) results. One used 100 units diluted hyaluronidase in only two spits. What is better to dissolve voluma and vollure over a large area, diluted or undiluted hyaluronidase?

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

Jason Emer, MD · Answer

This needs an in-person evaluation. The filler can be dissolved with hyaluronidase. Keep in mind, it will take a series of treatments. Best, Dr. Emer

Wenjing Liu, MD · Answer

Dear Xangelika,
Hyaluronidase is more potent when used undiluted since there is a higher dosage of the medication in the volume injected. It is best to inject it directly into the area where the filler is located and oftentimes can be felt. Multiple series of injections are usually needed to dissolve all of the filler and certain types of filler are more resistant to hyaluronidase than others. I would recommend consulting with a physician that is experienced in these injections.
Best,
Dr. Liu

Justin Harper, MD - Account Suspended · Answer

Hi Xangelika, Diluting is fine but I get best results by using Hylenex undiluted. However, the objective is not to dilute everything aggressively all at once. It is better to go slow and dissolve over the course multiple treatments.Justin Harper, MD.

Should hyaluronidase be used diluted with saline or undiluted to remove stubborn Voluma/Vollure over large area?

Answers (4)