Lips were overfilled and improperly placed. Tried to dissolve it with hyaluronidase but got an allergic reaction. Advice?

Question

I went to a doctor with 10 years experience in aesthetic medicine but unfortunately I got poor results. He put too much Teosyal in my lip line and I had lumps, bumps and cyst formation in my lips. I tried to dissolve it with hyaluronidase but it made things even worse as I had an allergic reaction to it and got severe swelling, I’m on a day 2 of Prednisone 50 mg. Anything else I can do to fix it? Can I lance the lower bumps out or use a human derived hyaluronidase?

Raffy Karamanoukian, MD, FACS · Answer

Hylauronidase has many advantages and should be considered in patients who are unhappy with their results or in acute cases of overfilling or occlusion. Its often better to reverse filler and restart then to deal with long term edema. 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

Steven F. Weiner, MD · Answer

Hylenex is recombinant human hyaluronidase and is what I always use. It shouldn't have an allergic reaction. It is very safe. It might take more than one treatment.

Prashant Murugkar, MD · Answer

Hi sorry to hear of your problems. Wait for settling to go down over the next few weeks. Then revaluate. All lip fillers disappear with time, dissolving lip fillers might leave you with an uneven result. Hope this helps warm regards Dr Prashant Murugkar

Richard Ort, MD · Answer

I would let the swelling subside and see what’s left after that. I would try to find out what brand of hyaluronidase was used. Vitrase is commonly used and is derived from sheep. Hylenex is a recombinant human product and may have a lower risk of allergic reaction. Sometimes a superficial filler nodule can be squeezed out through a needle puncture, but please do not try to do this yourself!  Make sure that you are seeing an expert injector.Regards,Dr. Ort

Liliana Marcu Awan, MD, FAAFP - Account Suspended · Answer

I believe that no one I know and have consulted myself with other physicians that would agree to having allergies to Hyaluronidase With that said maybe a dose of me drop dose pack although it is not allergic reaction may helpBest wishes Ft Lauderdale

Lips were overfilled and improperly placed. Tried to dissolve it with hyaluronidase but got an allergic reaction. Advice?

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