Nonsurgical rejuvenation of the eyes, cheeks, lower face and neck have become very popular in-office procedures in the past few years. Hyaluronic acid-containing injectable agents, such as Restylane, Perlane, Juvederm Ultra and Juvederm Ultra Plus are now used routinely not only for filling, but for volumizing, shaping and contouring of the eyebrows, the region under the eyes, smile lines, "marionette" lines and jowls. These procedures take only minutes to perform and often engender a "Wow!" reaction when patients look in the mirror immediately after treatment.
On rare occasions, particularly around the eyes, where the skin is especially thin (even in youth) and around the mouth, due to the anatomy of that area, small bumps or other irregularities may occur following the injection of any of these materials.
In these uncommon instances, enter the cavalry: hyaluronidase. Hyaluronidase is an enzyme that dissolves hyaluronic acid. Injected in minute droplet quantities, the hyaluronic acid fillers and volumizers can usually be dissolved away completely in one to three days. The enzyme seems to preferentially melt the injected hyaluronic acid rather than the native variety. All this makes a great "safety valve," and I routinely inform patients who are anxious first timers to fillers and volumizers that we have this treatment available "just in case" they feel they need it, which fortunately seldom occurs. The fact is that I store it in my office fridge just to reassure patients and have seldom ever have needed to use it.