Dissolving voluma. During that process is it possible that the product can melt, and drift downwards into other areas? (Photo)

Question

It's been suggested to me through a board certified plastic surgeon that during the dissolving of voluma in cheek area that the product had melted and drifted downwards into the NLFs and sides of mouth, Creating pockets of filler. I'm now being suggested to hyaluronidase these areas now. Is this possible for filler to redistributed during the dissolving process? I feel as though iv had to hyaluronidase my entire face to rid myself of this overfill from April.

Raffy Karamanoukian, MD, FACS · Answer

Hyaluronic acid fillers are often reversible with enzyme, but the injections of enzyme may also damage some of your natural hyaluronic acid. I would opt to be treated by a facial filler complication expert. Best, Dr. Karamanoukian Los Angeles

Mark K. Markarian, MD, MSPH, FACS · Answer

Thank you for your picture but it is difficult to assess the actual distribution of the Voluma without before-and-after pictures from different angles -- front, oblique-angled, and side views.  With that said, however, I do not expect the Hyaluronidase to have redistributed the dissolved Voluma.  The enzyme serves to dissolve Voluma but not move it around. Although Voluma is a great product, I would always make sure your surgeon or dermatologist has significant experience with it. As Voluma is a new filler manufactured by Allergan, most injectors' experiences are limited. I would seek out a plastic surgeon in your area who has extensive experience with injecting cheek fillers and typically performs many facial surgeries, as he/she is thus more likely to be familiar with the anatomy in that area, which can be variable even from one side of the face to the other. I would also ask for a plastic surgeon who took the Allergan Expert Hands-on training course specific for Voluma injection.Good luck

Brock Ridenour, MD · Answer

Vitrase is an enzyme that dissolves long chain sugar molecules such as HA (Voluma) into its component parts. It is a dose-related response and only the Voluma exposed to the enzyme will dissolve. Voluma is strongly integrated into tissue and should not migrate or drift downwards even if the product around it is dissolved.

Martin Jugenburg, MD · Answer

Thank you for your question, Hyaluronidase will dissolve product, it should not move product. Assess before and after photos to ensure there has been a change. Best,

F. Victor Rueckl, MD (in memoriam) · Answer

No. Hyaluronidase dissolves filler. It does not create a liquid that moves the filler around in it to other places. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

Dissolving voluma. During that process is it possible that the product can melt, and drift downwards into other areas? (Photo)

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