Tyndall effect tear trough wouldn’t dissolve with hyaluronidase - advice?

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

Hi, most like the dissolver did not reach the right bubble of filler. If you did like the first tear trough filling with your injector, the next interval for a follow up injection is between 2-5+ years. Fillers in this area lasts ridiculously long. Only if the patient loses a lot of weight or significantly ages will they need a top-off of the filler. If the patient maintains or gains some weight the filler lasts even longer. If you had your second session of filler around 1 year or earlier, most likely most if not all of your original filler that you liked was still there. So any additional filler will make it look like too much, too puffy, or create a dent below the puffiness. The injector will need to find the filler that was most recently injected, but in attempting to dissolve the filler your original filler which you liked may get dissolved along with it. If that is the case you may need to start over or refill the tear troughs later on. For now the goal will be to find the filler causing the problems and get rid of that first. If it looks decent close to your original filling session then maybe you don’t need to refill. Hope this helps explain what may have happened and provided some value to you. Good luck. Best, Dr. Yang

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case it would be best to leave this area for a month to settle before deciding what to do next. Dissolving filler from this area can be challenging and you may find seeking an alternative opinion may be helpful if you are unhappy with your current treatment. I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes