Old filler and new work? (Photo)

Question

Hi I’m 40 and have previously had mid face filler to target under eye appearance. Over 2 yrs ago. My injector who’s highly regarded has Rec Sculptra now. I see my cheeks are very uneven - is one side still holding on to a ton of filler ? Voluma I believe. Should this be dissolved before i do anything new ? I’m just looking for a little freshen up of my face.

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful question, and you’re not alone in wondering how to best layer or transition between treatments like Voluma and Sculptra.

At age 40, it’s perfectly reasonable to want a refreshed, balanced look. Since you’ve noticed visible asymmetry and it’s been over two years since your Voluma, a few things may be happening:

One side may be retaining more filler (Voluma is known to last up to 2 years or more in some cases).

Unevenness could also be due to natural volume loss or facial muscle asymmetry, rather than residual filler alone.

Should you dissolve it?
If the asymmetry is truly due to residual filler that’s still creating contour irregularities, yes, dissolving may be a good first step. Hyaluronidase (the enzyme that dissolves HA fillers like Voluma) can help clear the area for a more even, natural result—especially before introducing Sculptra, which stimulates collagen over time and is harder to reverse.

Here’s what I recommend:

In-person assessment with an experienced injector or dermatologist using palpation and possibly ultrasound to evaluate remaining filler.

If residual filler is causing distortion, dissolve it first, allow the area to settle, then reassess.

Consider Sculptra afterward for overall rejuvenation—it’s great for subtly restoring volume and skin quality without the “overfilled” look.

Remember: A “freshen-up” doesn’t always mean adding more. Sometimes, clearing the canvas is the key to restoring harmony and confidence.

Victoria Falcone, DO · Answer

It appear that your left cheek Voluma may have migrated. It can happen and should be corrected with Hylenex prior to further treatment. 
I suggest you research the Y-lift technique. It appears that you have lost facial volume in the anterior cheek. This is common at your age leaving the under eye with a more tired appearance. A Y lift could restore restructural volume under the muscle lifting your skin. Voluma is a good choice for the technique. 
You have a beautiful natural appearance. Sculptra is a good choice to support the skin but I don't feel it is the best choice for restoring the anterior cheek. 
A combination approach will likely produce an ideal outcome. Sculptra for overall skin support and Voluma for an anterior cheek lift.

Darryl J. Blinski, MD · Answer

Based on only one post of photo, my guess would be to do layered sculpting with nano and micro grafting under ultrasound guided injections. Best of virtual concert with fee $5000-$10,000. Again, best to virtual concert with.

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