Will Hyaluronidase Correct an Uneven Lip Augmentation Result?

I have recently had half a syringe of Hydrafill with a bad result - the product has collected in the wrong part of the lip and it's uneven. If I was to use hyaluronidase to correct an uneven result I have had recently with Hydrafill, would it dissolve all product in the mouth or would you be able to inject a tiny amount into certain areas without it spreading? I have been having injections for 10 years and am happy with the size of my lips, so I'm worried it will completely dissolve the Hydrafill and I will have to start from scratch. Thanks for any help.

Doctor Answers 6

Hyaluronidase for dissolving excess hyaluronic lip fillers

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The use of hyaluronidase for dissolving excess hyaluronic fillers (such as Restylane or Juvederm) is a not uncommon. Other approaches to improve excess filler or lumpiness includes insertion of a hypodermic needle to extract (aspriate) the product.

  • Before a physician uses either of these approaches it is essential to evaluate the lump to make sure that it is specifically excess product and not a granuloma or other type of mass that may potentiall occur after filler injections.
  • Before you visit another physician, obtain your past injection records and insist that this include product brand names and the lot numbers from any product injected into you to verify the legitimacy and origin of any injectable. (It is an essential and appropriate practice that the lot number or a sticker bearing the lot number of any dermal filler be recorded in your patient record at the time of injection). The brand and lot number will also be valuable in researching whether there have been adverse events associated with the particular product lot that you received.

Eugene Plastic Surgeon
4.3 out of 5 stars 14 reviews

Hyaluronidase is Non-Specific

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Unfortunately, hyaluronidase will fix your problem but you will have to start from scratch. By its nature, hyaluronidase will dissolve into the surrounding tissues and dissolve any hyaluronic acid in its path.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Can Hyaluronidase spot treat?

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Hyaluronidase injections are a valuable option when hyaluronic acid fillers need to be dissolved.  You are correct in being concerned with whether or not the hyaluronidase can "spot treat" just the one area that appears over-filled.  There is no way to tightly control where the enzyme will work and no way to contain the effects.  However, we have found that using very small amounts of hyaluronidase, combined with patience, makes this a good treatment option for many without reversing the total effects of the original treatment.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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Hyaluronidase is a protein enzyme that degrades hyaluronic acid and is  what makes the use of fillers such as Juvederm, Voluma and Restylane so appealing.  These hyaluronic acid fillers can be reversed if we don't like them!  It works almost like an eraser and usually does so within 24 hours.  This gives these fillers a huge advantage over others which cannot be reversed so easily.  That said, it is so much better to add incrementally than subtract and have to start over.  Expense is another issue to consider.  Everyone who injects fillers should have hyaluronidase on site and ready to go should the need arise.  

Paul Watterson, MD
Charlotte Plastic Surgeon

Hyaluronidase to reverse filler

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Hyaluronidase works like a charm to reverse HA fillers.  It usually does its work in 24 hours.  By its nature, hyaluronidase infiltrates and spreads from the injection site.  I would expect all the filler in the area to be reversed.  I think you will have to start over unless you are willing to just wait it out.  

The ability to reverse the filler is one of the many advantages of HA fillers.  Even the most experienced and careful injector can get a result that the patient just does not like.  Hyaluronidase to the rescue!

I do all my HA injections myself and also require my patients to stick with one injector (hopefully me).  It's very difficult to treat patients who have more than one provider injecting them.  Sometimes I have someone come in who was treated at a medispa and got a "great deal" on filler or Botox and had a poor outcome and I don't know what or exactly where or how much was injected.  Patients should find someone who does a good job and stick with them and ignore those "one time specials".

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Correcting an uneven lip augmentation with hyaluronidase

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Dermal fillers are an excellent option for lip augmentation. However, it is possible to develop an uneven result after an injection. Your best bet is to work with a board-certified plastic surgeon was a great deal of experience working with lip tissue and dermal fillers. They will be able to assess you and let you know if you would best be served by the addition of more filler into other areas to balance your result or a portion of the dermal filler may be drained, or if an injection of a small amount of hyaluronidase will correct this. Hyaluronidase is a powerful enzyme that can help break down a hyaluronic acid-based filler.

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.