Is there any alternative to hyloranadaise to break down H.A. filler?

Question

Since hearing recently there is evidence that HA fillers dont really dissolve on the own especially if they are cross linked (new mri research). I was wondering if there is anything else that helps break down crosslinked H.A fillers. Even if this process is a lot slower. The potential consequences of hyloranadaise does not seem with it.

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

Tim Neavin, MD · Answer

Hyaluronidase is used to dissolve hyaluronic acid fillers that have been placed incorrectly, excessively, or unevenly. It is injected into the same locations that the filler already is. It does not remove all of the filler entirely.

Nelson Lee Novick, MD · Answer

If you have been treated with a hyaluronic acid-based filler, which seems to be the case here, then hyaluronidase remains the treatment of choice for dissolving the material in the case of adverse reactions or undesirable aesthetic outcomes. Depending upon the location and the particular filler/volumizing filler used, different amounts and concentrations and number of treatment sessions of hyaluronidase may be needed. Other methods of hyaluronic acid filler removal that I have personal found successful in particular cases are the injection of anti-inflammatory agents, such as intralesional triamcinolone in varying concentrations and amounts and the use of subcision without or without the accompanying injection of saline to physically break up the deposits and make them more readily accessible to metabolic breakdown. A combination of all the above may be needed, especially when more robust injectables have been used. Make sure that you are consulting a board certified aesthetic physician. Hope this helps, and best of luck.

Is there any alternative to hyloranadaise to break down H.A. filler?

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