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Can Fillers Be Dissolved If I Don’t Like The Result?

Posted: 6:00 a.m. Sunday, Feb. 11, 2018

By Anita Mandal, M.D.
Question: I had my cheeks and under eye hollows injected with Juvederm. While I went to a plastic surgeon’s office, the surgeon had his nurse injector do the treatment claiming he’s too busy performing surgeries. Now I have bumpiness under my eyes and unevenness in my cheeks. Can the filler be dissolved?

Answer: Your situation is not uncommon and, in fact, is a growing concern. Not only has the minimal invasive facial injectables market become flooded with doctors who are not board certified in plastic surgery along with nurses and non-doctors performing injectable treatments, but there are too many plastic surgeons who pass the injectables task on to a lower level non-physician injector in their office.

When a plastic surgeon tells you they are too busy doing surgery, you should ask how much experience your surgeon has with performing injectable treatments. Often a surgeon won’t perform the treatments because he or she does not like to do injectables.

The fact is that these days many injectable filler treatments are for facial volumization which requires an in-depth understanding of the intricate facial anatomy of aging and a much higher skill level than simply filling lines and wrinkles which have traditionally treated been treated over the past 20 years.

Sadly, while the filler market has grown exponentially and extended to non-physicians or doctor’s who lack a proper aesthetic background, the techniques and skills needed for many of today’s facial injections are more advanced and should be executed by a plastic surgeon who is not only board certified but also one who specializes in facial volumization.

In answer to your question, only certain fillers can be dissolved with an enzymatic product called hyaluronidase. Such fillers include hyaluronic acid (HA) fillers such as the Restylanes, Bellatero, Juvederm and Voluma. Non-HA fillers like Sculptra, Radiesse and Bellafill cannot be dissolved with hyaluronidase.

Of the HA fillers, the Restylane family including Restylane Lyft, Silk, Refyne and Defyne and regular Restylane respond best to hyaluronidase. The cross-linking technology in Juvederm and Voluma make these products not as responsive compared to the Restylanes. Your options are to either wait till the Juvederm goes away or have your doctor inject hyaluronidase into the areas of bumpiness and asymmetry. The hyaluronidase tends to work quickly, often right away. Of course it’s important to note if any bumps are due to nodules or granulomas rather than filler itself, then kenalog injections would be the proper course of treatment so you should have the areas properly evaluated prior to further treatment.

A Board Certified Facial Plastic Surgeon who not only understands the complex surgical anatomy of the face but also specializes in injectable fillers is the first step in assisting you to optmize your results. Remember facial volumization requires more advanced injector skills than filling in lines and wrinkles.

 

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