Can Juvederm still be there after four years of waiting for it to dissolve?

Four years ago I had Juvederm injections in the nasolabial lines. Two syringes later The lines were filled out but I looked like a monkey, my face totally blown out. I was horribly bruised around my mouth but decided to accept my stupidity and wait it out, believing it would all be absorbed within 9 months. Four years later the sides of my mouth still look blown out in the areas where I was badly bruised. Could this still be filler after all this time and could Hyaluronidase be a solution?

Doctor Answers 7

It is possible for fillers to be encapsulated by the body, preventing their breakdown and staying for years in the body

Thank you for your question. I understand you had Juvederm injections in your nasolabial folds four years ago, which left you quite bruised. You decided to wait for the material to go away on its own, but four years later there’s still an elevation in the area, and you’re wondering if the material is still there and if hyaluronidase would be of value.

To first give you a bit about my background — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have certainly used a lot of fillers, such as Juvederm and Juvederm Voluma, in my practice, so I think there is an opportunity here for you to learn more about the use of fillers and my perspective on patient management of nasolabial folds.

The longevity of fillers has a direct correlation with the relative thickness or viscosity of filler. The thicker the filler, the longer it tends to last. These, however, are based on the level of the skin in which it is placed, and from actual clinical experience. As such, there can be a wide range of timeframes — some people can go through filler quite fast, while others can have it for years, like in your case.

A theory that many doctors share is that being that filler is a foreign material, it can become encapsulated almost in the same way a chin, cheek, or breast implant becomes encapsulated. This means that the body forms a capsule around the material which prevents it from breaking down.

In scenarios like this, I certainly do use hyaluronidase to remove the unwanted filler. I think it’s worth trying because the relative risk is low and you may actually get your normal anatomy back. There are times when patients come back again to have fillers dissolved because it reaches different layers of the body, so they think a little is left here or there, and they are usually right.

In terms of your disappointment with the outcome of your nasolabial folds, I think this is related to the standard philosophy and management of facial aging, and how too much is focused on chasing lines without looking at the facial structure as a whole. The challenge is that the nasolabial folds tend to look deep relative to the rest of the face where there is also probably age-related volume loss.

In our practice, what we do to address this is something called “structural volumizing”. We take a traditional hyaluronic acid filler and place it in the deeper structural levels of the cheekbones, jaw, and chin, in such a way that restores volume and definition. What’s fascinating about this is that I can do this and not put anything in the nasolabial folds themselves, and still improve their appearance.

Ultimately, it’s not just about chasing lines. Yes, there is value in softening lines in certain places, but there is also value in the restoration of the surrounding volume as well. Keep in mind that younger people can also have deep nasolabial folds without necessarily looking older, which means that there’s a lot more to facial aging than just the depth of these folds.

I suggest that you meet with a doctor you are comfortable with, and who has a lot of experience with hyaluronidase, to see what could happen in terms of dissolving the material. In the case wherein it doesn’t dissolve, then it may be due to some residual tissue growth caused by the response to a bruise or something like that. This, however, would require a physical examination and clinical determination by a qualified physician.

I hope that was helpful and I wish you the best of luck!

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Juvederm Filler Botox Toronto

Are you able to post some photos so that we can see what you're trying to describe? That way we can provide useful commentary. All the best.

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Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Juvederm and Years Later Results

I suggest you post before and after photos over time.  I have seen swelling years later but product minimally. I suggest a formal consultation with an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Juvederm and Longevity

Juvederm can not last for four years.  If you want to post a photo to assess the problem, please repost the question with your photo.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Juvederm Facial Injections

Hi Calyros,

Thank you for your question.

It is not likely that you have any Juvederm left four years after being injected.  Some of the latest Vycross products have better longevity than the Juvederm products that were available 4 years ago but the longest we have seen HA injections last is about 2 years when we correct the tear trough.

I think that there was likely some misadventure when you were treated.  Most patients do not have extensive swelling and bruising after being treated.  If you injector put 2 vials into the nasolabial fold, they likely have minimal experience in facial rejuvenation with HAs. 

I would seek out the opinion of an experienced injector.  Ask you friends, who have had injections in the past and that look good, who does their injections.  In every city there are many injectors but very few who have the aesthetic eye and experience to create natural youthful facial reflation and volume correction.  An experienced injector would have restored your cheek shape and volume with the injections over the cheek bone and mid-cheek and placed minimal juvederm into your nasolabial fold. 

When you are seen in consultation, the physician should spend a great deal of time assessing your face and educating you about what would optimize your result.  They should be well versed in many different HA products and what would be best for each area of your face.  Facial aesthetics is an art and while many can paint, there are very few that have the experience, aesthetic eye and knowledge to create beautiful natural long lasting masterpieces. 

It is your face and it deserves to be treated by an expert in your area.

All the best,

Scott Barr, MD, FRCSC, Plastic Surgeon
Director of

Scott Barr, MD
Sudbury Plastic Surgeon
4.8 out of 5 stars 39 reviews

Can Juvederm still be there after four years of waiting for it to dissolve? The answer is NO

It is not likely that Juvederm is causing this problem 4 years after injection.

I recommend that you see a facial plastic surgeon for evaluation and treatment.

Dr Karamanoukian

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Can Juvederm still be there after four years of waiting for it to dissolve?

Hello Calyros,

Juvederm or any other hyaluronic acid filler would not still be there 4 years later.  Its possible you developed a granuloma but this is not common.  It oculd also be scar tissue that developed from the previous trauma.  It could also be from something else.  I'd recommend you get evaluated by a physician injector to determine what if anything can be done.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.