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POSTED UNDER Hyaluronidase REVIEWS

If You Can Live with Your Filler Results, Don't Go for Hyaluronidase

ORIGINAL POST

I had hyaluronidase after an "overfill"...

eyeschicagoFebruary 11, 2010
$175

I had hyaluronidase after an "overfill" of Restylane that left my undereyes kind of baggy (never had a problem before, it's always looked great in the past). Mind you, it was an "OK" result, just not great. So I went in for the hyaluronidase -- had to go to a plastic surgeon as my derm said he didn't believe in doing it because it can dissolve your own tissue along with the Restylane.

Anyway, the plastic surgeon said this was a myth and that it would improve. I insisted on a very small amount of the Vitrase (he wanted to inject more). Within minutes it started to dissolve. Problem was, it really only dissolved the area of the tear trough itself -- NOT where the Vitrase was placed, as I am positive he did not place it in the tear trough (just two quick injections where the Restylane filler was too bulky). Within days I had two rather narrow and VERY DEEP "troughs" that were more like creases. I did not even recognize myself. They were dark because of my own pigmentation but also because of how deep they were.

I went back to the plastic surgeon and had to pay AGAIN for Restylane filler. The total of this nightmare was over $1,000 for adding more, less, etc. I am ALMOST at a good result, although I still have a faint trace of the crease below my right eye -- at any rate, it's much improved, but this was a nightmare, and I think the docs are very cavalier in insisting that there's no risk at all with Vitrase.

My plastic surgeon was surprised by my poor result, as was his nurse, and when I gave him the names of a few very well known surgeons who don't advise hyaluronidase he was surprised and promised to look into it. So, unless you feel you are horribly disfigured I recommend patience. The creases I have from the Vitrase that are underlying the filler I just had to replace are, I guess, permanent.

Replies (85)

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tried but failed
February 11, 2010
I too had a similar result with hyaluronidase so I feel your pain. Dissolving filler with hyaluronidase is not FDA approved and it has only been used for this 'off label' purpose since 2006. Some doctors think it damages natural tissue and some think it does not. From my experience, it does. I wish I had been warned of this as I would have just waited for the filler to dissolve on its own.
eyeschicago
February 11, 2010
Yes, I was really sorry to hear about your result. I hope you are getting better now. Did you determine whether it was an allergy?
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tried but failed
February 12, 2010
I don't think it is regarded as an actual 'allergy' - more of a hypersensitivity reaction, but I really don't know what the distinction is. At the end of the day, it is powerful stuff and not enough is known about its effects when injected directly into the skin. I will be interested to know if you think the hyaluronidase caused damage to your skin in the long term or not. I am sure it caused damage to mine, particularly bringing melanin and hemosiderin deposits to the surface. The discolouration under my eyes really is awful. Wishing you the best.
eyeschicago
February 24, 2010
I absolutely do think it damaged my skin, both in the tear trough area and on the inside corner of my upper lid, where it was not injected, as these areas are now purply-blue. I can't swear to this because I do not know for a fact. But I am 75% sure. It drives me nuts that doctors fly in the face of online testimonials and claim that because they personally haven't seen any damage (and don't believe it) and because there are no clinical studies out there proving it, there is no damage. No one has tested this drug in this application. Use of hyaluronidase as an agent in eye surgery is not the same as a direct injection to the face. This is a spreading agent and it will go to places that were not filled by restylane -- that is, anywhere where there happens to be a concentration of hyaluronic acid. For some people, those concentrations won't just be where the filler is. Skin is a complicated organ. Doctors give it the brush-off, and I would also like to remind them there's no clinical "proof" that this stuff WON'T harm natural tissue, and logically it would seem very likely to do so as the skin has so much hyaluronic acid.
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tried but failed
February 26, 2010
I could not agree with you more, chicagoeye! I have gone on a bit of a "I can't stand looking this bad anymore" rant so have replied to you as a comment below. Wishing you the best. Cheers.
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docblinski
February 11, 2010
Maybe you should have just let the Restylane dissolve over time like 3 to 6 months? Just a thought. From MIAMI
eyeschicago
February 11, 2010
Agreed! I am lucky I look fine now.
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tried but failed
February 12, 2010
I am really happy to hear that!!
Mishka
March 1, 2010
What the heck! How does it HELP in any way shape or form to make a comment like that? This is just SO typical M.D. and so typically male. I think you should let someone stick a few vials of this crap in your face,and tell you to "live with it for six months" My god some of you doctors are completely heartless!!!
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tried but failed
March 2, 2010
Hi Mishka - I think Dr B just meant that maybe it is a better option in general to let filler dissolve naturally than to dissolve it with hyaluronidase. Dr B's responses are generally very kind. I totally, totally, totally get how upsetting this is for you though. I am in the same boat! K
eyeschicago
March 2, 2010
I am sure the comment was meant well. However, the title of my post pretty much said that you should wait rather than have the hyaluronidase, so what the doc said was not very insightful or helpful ...
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tried but failed
March 3, 2010
Fair enough. Agreed.
selfimposedhermit
October 23, 2016
late comment, here but... if the filler was placed in the wrong area of the skin, as mine was, too superficial, it will not dissolve so quickly on its own. I was messed up and now am opting for a facelift to correct what never needed to be done. (poorly placed filler). it's been almost a year of depression, hopefully will end soon.
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tried but failed
February 26, 2010
Injecting hyaluronidase directly into the skin to dissolve filler is new and not formally tested. There have been NO clinical trials as to long-term effects. How can doctors positively assert ANYTHING about what hyaluronidase does or doesn't do to natural tissue? Easy answer - they CANNOT. Hyaluronidase is not FDA approved to dissolve filler and has only been used in this application since about 2006. Doctors rely on data relating to the use of hyaluronidase in its FDA approved application of dispersing anaesthetic agents during eye surgery to claim that dissolving filler with hyaluronidase is also 'safe and effective'. This conclusion is NOT logical and we are NOT stupid. THE TWO APPLICATIONS ARE COMPLETELY DIFFERENT!! Moreover, some people ARE allergic to hyaluronidase and this allergy is documented in medical journals. Google the exact phrase using quotation marks "Delayed allergic reaction to hyaluronidase". It is the first hit. It is a journal article about a patient who had an allergic reaction to hyaluronidase following cataract surgery. The article also cites examples of other people who have had allergic and/or hypersensitivity reactions to hyaluronidase. Note in particular the following quote from the article: "She was skin-prick tested for lignocaine, bupivicaine, hyaluronidase, adrenaline, mepivicaine, prilocaine, rubber, latex, and house dust mites. Skin-prick testing was strongly positive for hyaluronidase but negative for all other allergens." HEADS UP DOCTORS - SOME PEOPLE ARE ALLERGIC TO HYALURONIDASE! Therefore, even when hyaluronidase is used in its FDA approved application, it can cause an adverse reaction. So it would logically follow that it could also cause an adverse reaction when used to dissolve filler. It is not rocket science! Injectables is a relatively new area of cosmetic medicine. More doctors should use websites such as RealSelf to LEARN more about the experiences people have (good and bad) with various products and procedures in the injectables field. Instead, there seems to be this constant need to DENY that anything bad can happen with injectables. THIS IS ABSURD AND BAD THINGS CAN AND DO HAPPEN. Is the reason doctors deny the possibility of hyaluronidase causing tissue damage so that they can sell more juvederm/restylane? Maybe. It certainly seems to make people feel more comfortable using hyaluronic acid-based dermal filler to know there is an 'antidote' to remove it if they don’t like the effect. If this is the reason for denying hyaluronidase might cause damage to natural hyaluronic acid (when doctors could not possibly know this for certain), then it will ultimately be self-defeating. To my mind, a doctor who does not know that some people are allergic to hyaluronidase and/or a doctor who will not admit that it is even possible that hyaluronidase injected into the skin could cause damage is ILL-INFORMED and IRRESPONSIBLE. TO ANYONE THINKING OF DISSOLVING DERMAL FILLER WITH HYALURONIDASE: Ask your doctor about the possibility of an allergic or otherwise adverse reaction. INSIST, INSIST, INSIST on a skin test BEFORE you let anyone inject hyaluronidase in your face and especially around your eyes. Ask about the possibility of damage to your natural hyaluronic acid and natural tissue. PLEASE DO NOT be fobbed off by words like ‘rare’ or ‘unlikely’ – this still means that a bad outcome is a possibility or it means your doctor simply does not know. Take before and after pictures in the same place under the same light. If you feel that your valid concerns are being dismissed then ASK YOUR DOCTOR TO PUT IT IN WRITING that nobody is allergic or hypersensitive to hyaluronidase and ASK YOUR DOCTOR TO PUT IT IN WRITING that hyaluronidase does not and cannot cause any damage whatsoever to natural hyaluronic acid, natural tissue and/or natural collagen. I can almost guarantee that no doctor will give you this absolute assurance because they simply cannot know either way. YOUR FACE IS NOT A SCIENCE EXPERIMENT AND YOU SHOULD BE INFORMED OF ALL THE RISKS ABOUT HYALURONIDASE BEFORE YOU DECIDE IF THEY ARE WORTH TAKING OR NOT. Some people have success with hyaluronidase and for others (me) it is a huge disaster. If you are already so unhappy with your dermal filler to be considering dissolving it then the decision to use hyaluronidase should not be taken lightly because you are taking a risk of making the situation even worse.
eyeschicago
March 2, 2010
Thanks for your post. If only doctors would heed it! I am wondering how your face is doing now that it's been several months since the hyaluronidase and several months since the botox was given to "correct" it. Did the swelling and blackness diminish at all? I think our experiences with hyaluronidase are very similar. In my case, I had hyaluronidase but only in a tiny amount and it did not dissolve the filler completely ... and unfortunately it gave me a darkness and troughs in those areas. I had a small amount of filler put over the black troughs, and for a couple of weeks it looked great but now it appears to be wearing off so I am left with a poor result again. I may need a lower bleph and had been considering it anyway, but here's the thing: with filler still in my face I'll have to wait for it to go dissolve before I can do the surgery.
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tried but failed
March 3, 2010
It has been 9 months since the hyaluronidase and 8 months since the botox horror. The darkness under the right eye has improved a bit but the left is still very puffy and baggy, the skin is loose and without makeup it looks like a black eye. Makeup (a considerable amount) can cover the black line under my right eye if I try really hard but no amount of makeup can conceal the black line under the left eye. Both of the dark lines are more visible in certain lights but I am confident it is not the Tyndall effect because the juvederm is under the muscle along the bone where it should be. I think it is long-term bruising, hemosiderin staining or clusters of broken blood vessels from the hyaluronidase and/or all the injections. I have looked into vascular laser but I am super scared to try it as everything else has gone so wrong! After all this time I still have a considerable amount of juvederm left in my tear troughs and I also have the same concerns as you regarding a lower blepharoplasty when filler is still present but there is no way I am ever having hyaluronidase again! I also don't know if it is best to try the laser treatment for the discolouration before or after a blepharoplasty. Total dilemma. Some of the puffiness under my eyes is from pseudo-herniated fat pads caused by the botox fiasco, and I want to let this wear off before any lower bleph too. Waiting sucks but I would rather wait than have another disaster. The muscles around my eyes are still extremely weak and my cheeks are still dropped from the botox in crows feet, so I a lower bleph is out of the question until that is back to the best it can be. I figure I will know when this is when there is no change for six weeks in a row. At the moment, my face is still changing. Have you ever had botox around your eyes?
eyeschicago
March 3, 2010
Yes, I had Botox in the crows feet area at the same time as my first round of Restylane but had no negative effects with the Botox (and had had it in crows feet before). My problem stemmed from a too-superficial placement of Resty that my p.s. tried to correct with hyaluronidase. Last night I looked at it very carefully in various lights and I'm convinced the darkness is mostly a shadow -- there's a line of demarcation between this bulky, whitish shape of Resty under my eye and my cheek. It's uneven so it looks dark, but when I gently pull the skin taut the darkness disappears. Makeup helps but is not a solution. Like you said, daily changes are encouraging. Brooke Seckel says that gentle massage will get the Resty to disappear faster.
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tried but failed
February 26, 2010
Sorry for the massive rant on your review, chicagoeye. I am having a 'bad face' day and needed to get rid of some of my anger and frustration!
meltyface
February 27, 2010
i agree wholeheartedly with the posts above. if you can live with the filler do not used the hylase .. my face is disfigured and my skin 'bonds' have been broken (the glue that holds my face together). i am praying that it is not permanent but i now have two huge troughs in my face and (when pinched) 1/4 inch of skin laxity..and my mouth has sagged so i look like homer simpson (not kidding). do not be reassured that it won't damage your skin because i'm sure we are not the only 'victims'.. hopefully more will come forward...
eyeschicago
February 28, 2010
No problem! Your comments are very helpful. Honestly, I will say again that unless you feel really self-conscious about your filler (it looks TERRIBLE) then don't get vitrase. Also, go to a really good person who is famililar with injectables. Also, I wanted to say as well that the "skin allergy test" is not a sure bet you won't look awful after vitrase. I insisted on a skin allergy test and I had absolutely NO reaction in my arm. There was one clinical study of hyaluronidase to test its effectiveness in reducing hyaluronic acid filler, and, you guessed it, the test was done ON THE ARM. The face, well, the skin is thinner there, especially near the eyes. I am quite purple in a couple of places around the eyes and the bridge of my nose; I never had this before. It is odd b/c that is not where he put the vitrase (hyaluronidase). He put it about an inch below the eye on each side, but its effects were in the tear trough area and the bridge of the nose. Remember, it's a spreading agent. My derm predicted this reaction and had seen it before; I should have listened. I have never had bluish discoloration anywhere in my face and now I do, and it was immediate with the vitrase. It seemed to make my skin very thin in only a few areas, and NOT where it was injected.
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tried but failed
March 1, 2010
Good to know about the skin allergy test - thanks for sharing that! And I would love to read the results of that trial. I looked everywhere for some sort of testing (I subscribe to online medical journals) but I couldn't find anything. I am sure your discolouration is caused by hyaluronidase. I got the discolouration to my skin almost immediately following the injections. They were very evident the following day. Mine is purple/black under my eyes and rusty coloured (brown/red) where it dripped down my cheeks (on the inside of my skin). I think it brought hemosiderin and melanin deposits to the surface. And the skin is very crepey and loose in those areas - it has a different texture from the rest of my skin and it looks 'older'. I agree that hyaluronidase spreads A LOT under the skin. The discolouration on my face kind of marks out how far it spread and it went quite a long way away from the injection site. You can see from my discolouration that gravity got to it too hence the discolouration looks like it has dribbled downwards under the skin surface. How long ago did you have the vitrase? Has the discolouration or thin skin improved any? I had it 9 months ago. There has been a bit of improvement for me but not a lot. I still have the discolouration, thin crepey skin and a sort of depressed area (not as deep as an indent but visible under overhead lights) just under where it was injected. I am going to try a silica supplement and see if it makes any difference. Nothing to lose. Cheers, K
eyeschicago
March 2, 2010
Here is a link to the study I was referring to where they did a clinical trial: http://archfaci.ama-assn.org/cgi/content/full/7/4/231. The injections of restylane AND then hyaluronidase were made to the forearm (as my skin allergy test was), not in the delicate areas of the face/near the eyes. By the way, I do not think I had a "reaction" to hyaluronidase. I think it just made the hyaluronic acid in my skin thinner so then you have baggy skin and in my case dark bluish pigmentation (veins showing through the thinned skin).
eyeschicago
March 2, 2010
By the way, no, my discoloration is worse than ever. It was partly resolved a couple of weeks ago when the plastic surgeon added a small amount of filler over it, but it was a very small amount and the bluish line under my right eye is showing through (looks almost black in some lights but oddly disappears in other lights). Today I went to the drugstore and bought a yellow concealer and put a heavy skin-colored concealer over that. Both were by Physician's Formula. They helped! I know you've been quite unhappy. Do you think the Restylane is all out of your skin at this point, and is there any chance you have Tindall effect (I know some of my darkness is due to that, as well as the pigment problems you refer to)? Have you looked into (1) bleph (I have a doc's appt next week) or (2) laser treatments to improve texture under the eyes? Brooke Seckel is the doctor I'm looking at. He's in Boston. He doesn't do hyaluronidase (he knows it's damaging!) or injections under the eyes (because of the risk of blindness).
eyeschicago
March 2, 2010
By the way I had the first restylane (botched job) about two months ago and the hyaluronidase about a month ago, with more Resty filler about a week after that. I had the same thing you did: blue black lines the following day. I too noticed the "drip down" in the skin (reddish) on the cheek area, but that was only the day of the injection and while it shocked me it did resolve right away and did not result in an indent in my cheek area. One thing you have said that I find encouraging ... you are not left with huge indents. That is the biggest fear b/c no amount of makeup can hide it. I have really deep creases under my eyes, now part hidden by the restylane. I wish I could show you photos of my before and after. I do think part of this is just aging skin -- at age 41 my skin doesn't "take" filler the way it did when I started five years ago at age 37. Have you tried any laser treatments or anything to resolve this? I am thinking of that or bleph. Sorry for so many messages today.
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tried but failed
March 3, 2010
Eyeschicago, we are having a pretty similar problem with undereye filler and hyaluronidase so I am GRATEFUL for your posts and information. Absolutely no need to apologise. (You just don't have the added problem of a botox disaster on top of everything which I have to factor when trying to sort out the issues.) I have replied to your questions on another of your posts. I really don't think it is the Tyndall effect. The juvederm in my tear troughs can be felt through the skin. It is under the muscle along the orbital bone where it should be. Mine also shows up more in certain lights but I still don't think it it is the Tyndall effect. I think it is a combination of long-term bruising, hemosiderin staining and broken blood vessels from the hyaluronidase and/or all the injections. I have looked into laser for the discolourations - scared! I have also looked into a lower bleph - terrified! I have written more about this in my reply to another of your posts. I also think Brooke Seckel would be an excellent choice!! I live in Australia so unfortunately I am just too far away for a consult. Please let me know what he says to you and what you decide to do. Cheers, K
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tried but failed
March 3, 2010
Thanks so much for the info! I particularly love Figure 4 showing the localised allergic/hypersensitivity reaction to hyaluronidase. If that is what can happen in the ARM, no wonder the area under my eyes looked so bad after those injections! Jees. Why don't they warn us??? I would have just waited it out. One of the reasons I am scared to try laser on the discolourations under my eyes is because of the report of volume loss from laser on RealSelf. I ALREADY have volume loss from the hyaluronidase and do not want to make it worse!!! Dilemma, dilemma, dilemma. I really hate the way I look and I really want to do something about it after waiting all this time but I could not bear another disaster.
Kate B
February 24, 2013
I am having a similar problem. It has been three years since you posted, have you noticed your skin has regenerated at all? I'd really love to know if it has. Thank you.
eyeschicago
February 28, 2010
Sorry, this was meant as a reply to "tried but failed"'s post today.
UPDATED FROM eyeschicago

Hyaluronidase update

eyeschicagoJuly 26, 2022
I'm 12 years on now, and I would revise this review if I could ... I don't think hyaluronidase was the true problem. I don't think I had enough of it and therefore it did not get fully out, leaving me with lumps where residual filler remained, and also that i had bruising at the injection site. That said, the more filler you have, the baggier your skin will look after treatment with hyaluronidase. One thing I'll say -- if you are going to have a bleph and already have filler on cheek or tear trough or eye area, ask for the hyaluronidase (remover of filler) well before your surgery. Your skin should be in good shape when you have surgery so that the surgeon is dealing with an essentially blank canvas. My own surgeon said he's not sure he got all the filler out during my bleph. Now I don't know if that's true or if what's left is fat. Not a great position to be in post-bleph.

Replies (1)

eyeschicago
August 17, 2022
Recently learned I'm probably allergic to hyaluronidase as I am allergic to various insect stings including bees. This may account for my bad reaction with increased swelling and possibly rash, which I experienced after my last bleph during which the surgeon apparently used hyaluronidase.
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