How many doses of hyaluronidase to dissolve this volume? (photo)

Question

I am on the third hyaluronidase dose to dissolve one cheek from Voluma as it keeps swelling up and causes pain..(Other dissolved first time) I am on a constant high dose of steroids to stop the swelling.. I just want this hard mass out of my cheek so I can stop steroids and the swelling stop..

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

Carlos Mata, MD, MBA, FACS · Answer

Hello there,I'm sorry to hear about your concerns.  Unfortunately, there it takes several rounds of treatments with hyaluronidase several days apart in order to complete.  The doctor should be using the same length of needle in order to inject in the same areas.  A good rule of thumb is approximately the same amount of hyaluronidase should be used as the amount of HA filler injected.  Hope this helps.All the best,Carlos Mata, MD, MBA, FACSBoard-Certified Plastic Surgeon

Jason Emer, MD · Answer

It's difficult to give you an estimate, but it will take a series to dissolve. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Jenny Weyler, MD · Answer

Voluma products can take higher doses of hyaluronidase to dissolve, so if you still have swelling, you should return to your injector to see if they can inject more. I use Hylenex in my office, and have read that Voluma can take up to 200 units of Hylenex to dissolve, which is more than one vial, which is a fair amount of Hylenex. You should see the results of Hylenex within 24 hours, as it really works quickly, so no need to wait days to return for re-injection.

How many doses of hyaluronidase to dissolve this volume? (photo)

Answers (4)