Overfilled nasolabial folds. Do you recommend dissolving the filler? (Photo)

Question

Hi, I've done fillers twice in 2 years, in my nasolabial folds. After doing it a second time, about 4 months ago, I found that one side (the most marked fold) was overfilled. It makes me look muzzled. And yet the fold is still very visible (perhaps even more so?). Do you recommend dissolving the filler (hyaluronic acid)? Getting more on the other side? Or just wait it out? Are there any options for folds like mine? I am under 30. Thanks!

Raffy Karamanoukian, MD, FACS · Answer

There are many options if you are unhappy with fillers. Hyaluronidase enzyme continues to be an excellent option for patients with fillers that need to be dissolved. Fillers can swell and migrate unpredictably, especially when a filler with a high-edema quotient is used in thin areas. Our office uses disciplined approaches to help patients with acute or chronic issues related to hyaluronic acid fillers. We begin by assessing for any tissue compromise and advocate early treatment to avoid complications with vascular occlusion. In chronic issues, it is important to gradually break up and dissolve filler so there is no further migration of loose filler substrate. Conservative staged dilution may also help avoid volume loss. If the filler is not dissolving, we may consider stronger concentrations or surgery or determine if there is biopolymer that is synthetic and permanent.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nima Shemirani, MD · Answer

Hi @Kelly_Smith8! Hyaluronic acid facial filler products can be dissolved by hyaluronidase injections. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

you can reverse fillers here but it appers you have sagging that needs tightening such as at home derma-rolling, and in office morpheus, threads, and thermage/ultherapy --- along with well placed fillers.

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly, see linkt) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Michael Kulick, MD, DDS · Answer

Hello Kelly,
It's hard to tell with the photo's provided due to different lighting in each. You can try and dissolve the HA filler and start from the beginning. This would accelerate the natural process of resorption. I see this in patients where the filler was injected too high which can make the naso labial fold look worse. The best thing to do is seek out face to face consultation with board certified doctors. It would be helpful if you had  some non-smiling pictures of your face prior to receiving any fillers.
Sincerely,
Michael Kulick MD
San Francisco, Ca

Dmitriy Schwarzburg, MD · Answer

Hyaluronidase is designed to dissolve fillers made of hyaluronic acid. If you are not satisfied you can always have it dissolved. Consult with your doctor to know more.

Overfilled nasolabial folds. Do you recommend dissolving the filler? (Photo)

Answers (5)

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