Injectable fillers work wonders, and for some, they’re a godsend because they instantly add back lost volume and rejuvenate the face in mere minutes. But, there are some of us who go in for injections, hoping to get a good result, and wish that nothing was ever done.
“Intradermal and subcutaneous fillers have been a wonderful additional to our armamentarium to reverse premature facial aging,” says Newport Beach, CA, plastic surgeon Sanjay Grover, MD. “Fillers can provide beautiful, natural results when placed properly with the proper amount and with the appropriate fillers. But there are occasions, however, when patients can end up with results that are less than ideal.”
Because all hyaluronic acid injections may cause swelling, New York facial plastic surgeon Jennifer Levine, MD, usually recommends applying ice to the area for the first 48 hours and gently massaging it, too, if there is any irregularity. “Usually, at two weeks the product has settled and swelling has dissipated so if the patient wishes to reverse their filler they can do so at this time. An exception is vascular compromise, in which case the product should be injected immediately or as soon as it is recognized. Or, if there is prolonged edema after under-eye filler, which may have to do with blockage of lymphatic drainage of the area.”
For whatever reason you don’t like your injections—be it asymmetry, lumps and bumps, irregularities, overfilling, inflammation or an infection—the good thing to know is that as long as hyaluronic acid ones (Juvéderm Voluma, Volbella, Volure and Ultra, the Restylane products, and Belotero Balance) are used, they can be reversed. “The hyaluronic acid fillers are readily reversible with the injection of a protein enzyme called hyaluronidase,” explains Dr. Grover. “It can be injected in small amounts to rapidly dissolve the hyaluronic acid.” Products that contain calcium hydoxylapatite, collagen suspension with beads of polymethylmethacrylate like Radiesse, Bellafill and Sculptra Aesthetic, or even human fat, can’t easily be reversed and usually require surgical excision to undo the results.
Dr. Levine says hyalurondiase comes in two forms. “The first, Hylenex, is human recombinant hyaluronidase. The second, Vitrase, is ovine (sheep) hyaluronidase. There’s less of a chance of an allergic reaction with Hylenex, but both work quickly to dissolve filler. The dose used it dependent on the type of filler and amount that needs to be dissolved.”
Once the hyaluronidase has been injected into the area, it can take anywhere from a few minutes to a few days for the product to be dissolved and for everything to return back to baseline.
“It’s common to see a patient requiring hyaluronidase following injection to the tear trough or under-eye area. The area is less forgiving as the skin can be quite thin with poorer elasticity and irregularities may occur here more frequently,” says Dr. Grover. “Another area that may require hyaluronidase is the lips because they are frequently overinjected and easily reveal lumps and bumps.”
To reduce the chances of adverse effects from fillers and ensure that you’re happy with the treatment, make sure to always seek out a skilled plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatologist when it comes to your injections—this is not the time to start bargain shopping or let an aesthetician, general practitioner or hairstylist inject you.