hi i'm dr johnny thanks for joining me
today
removing lip filler dissolving lip
filler
dissolving under eye filler removing
botched under eye filler
these are all things i get asked in the
run of the day here
on instagram especially through
instagram messenger i get a lot of
pictures
what do i do what do i do understand i'm
gonna go through dissolving filler
what's involved does it get rid of your
own
stuff your own hyaluronic acid will it
ruin you for life how much you use
why does it fail a lot of people are
asking me i tried four times the
filler's still there
is it a malar pad the two most common
areas of dissolving are going to be the
under eye
and the lip or they just want a
different look
we're going to dive into it raji's quick
clip we'll keep it to under
four minutes today i want to get this
important information to you
thanks for joining me stay tuned three
seconds
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these are important ones because i'm
giving you what i'm being asked
on instagram and one of the things
that's common
is i tried to dissolve filler it didn't
go away
the other one i got just recently today
was hey
i dissolved my under eye it was three
years ago could it still be filler
and is it could it be a fat pad because
it didn't go
after dissolving so i thought i'd go
through what are the top
reasons dissolving fails first of all
there's five types of active or
functional hyaluronidases that occur
naturally in the body and what we're
doing
is we're trying to dissolve hyaluronic
acid filler
with an enzyme hyaluronic daze which has
been used for a long time
and there's many different types so the
hyaluronidase
is exogenous it's not made in our body
there's two main types used
one recombinant dna such as hyalinex and
then there's the animal derived the
ovine or the bovine type
that are have animal origins and
are really testicular in nature for the
most part
and that's where the enzyme comes from
and it dissolves
hyaluronic acid therein lies the problem
a couple things one it does predictably
remove hyaluronic acid a lot of people
say hey
vicross needs five or six times there
are different types of fillers
it needs much more look i see it all
i see all kinds of different hyaluronic
acid fillers i use them all
i don't find differences it's very
difficult to tell it's been in different
locations
some of it migrates filler lasts for
many years the studies talk about a year
but understand that's the efficacy of
the result
as it migrates if it reduces by 30
and so on the result goes doesn't mean
all the fillers gone
so it's important to understand it can
last a long time that's why people
dissolve it
because of migration it can draw water
and it holds on to water
it doesn't look good now why might it
fail
a very common much more common people
think fake filler
what it may mean fake people use fillers
or get fillers that aren't
from this country aren't from the
manufacturer
aren't what people think so a lot of
times they might be bio-alchemic or have
bio-alcohol components
pmma particles silicon very cheap to use
silicon 1000 and
people are getting that those things do
not dissolve
so if you're going to places where
you're price cutting you're looking for
the best
deal sometimes it's not the best deal if
you're ordering from
places that you don't know in other
words not
direct from the manufacturer until that
these the packaging everything looks the
exact same even to the companies
they have to put under the microscope
until they know and it's a disaster when
it occurs
so everything's good until it's cheap it
works but when it doesn't it doesn't
dissolve
you have surgical removal is the only
option and
a lot of times you can't even get out
with surgery if you've ever done it or
seen it
the particles are dispersed everywhere
there's scar tissue it's a mess
so first question is is it hyaluronic
acid
second what type of product
was used what type of hyaluronidase asia
and europe there's even different ones
not that they're bad they're just
different the dosing is different
the efficacy is different also there's
compounded versions
as well it needs to be kept cool and
there's expiration dates
a lot of people don't like spending the
hundreds and up to a thousand dollars
every several months to replenish them
if they're not using a lot in their
clinics so they might be there in a
clinic if they're not seeing high volume
or they're scared of dissolving because
they think it's going to get rid of the
natural hyaluronic
acid they might not use it for two years
it's expired stuff
so you wouldn't know if it hasn't been
kept cool it loses its efficacy
quicker we used to use hyaluronic days
in mesotherapy that's how i know a lot
about it
okay so those are some pitfalls of why
it might not work
if all that is right you have a
hyaluronic acid filler
you have the right hyaluronic days it's
not expired it has been
stored properly that's a lot of problem
with people ordering all kinds of
products such as
botulinum toxins it's not that they're
maybe even not real
but to get to you they weren't kept cold
so they the efficacy
isn't there and it can be dangerous to
use those so
storage and handling was good the next
question becomes
two things what was the dose used
everybody's scared is going to get rid
of your own hyaluronic acid while that
may happen
you make hyaluronic acid all the time
oculoplastic surgeons use
high doses of hyaluronic acid hyaluronan
days
on a regular basis because it's a
dispersant by nature
it's used to for numbing different areas
it's used in ocular surgery
and it doesn't get rid of the the native
hyaluronic
acid that's in there and if it does it
replenishes but i know people on this
channel
and someone sent me an article a poor
article but it was an article
that hyaluronidase can um botch someone
for life by removing
their own natural product for long
periods of time certainly
things can happen we don't know
everything that's for sure
and in a select group of people maybe it
could not common
when there's a potential occlusion we
put hundreds of doses of
highland or units of hyalinex in and the
patient recovers fine
and there's no loss of of natural
hyaluronic acid for any period of time
so the dose the final thing is what
layer it's put at
is it puts superficial is it put deep
this
isn't an exact science so yes if you
want a little bit gone you can put in a
little bit of product at
the the right layer it's a dispersant so
it's going to spread to areas where you
might not want the filler removed
it's complex i do it a lot i see it a
lot i've used it for so many years
i can guesstimate the dose where to put
it how to put it
and i'll be right most of the time
sometimes i will get rid of a little bit
of filler i don't want to
it's part of it um but you can easily
add
more so understand the complexities when
you guys send me
hey i dissolve my under eye it still
looks the same
that could be because the filler was
four or five years ago now there
is herniation of the fat pad there could
be a malar fat pad
or demarcation line now around the fat
pads of the face that wasn't there five
years ago
or all those problems with that
dissolver occurred
in in the eye we're also talking about
poor
lymphatic drainage from fillers that can
take
months to resolve sometimes it doesn't a
lower bleph is needed
o complex i don't want to make it
complex but i want you to understand
what goes through the mind
of an injector has done something for a
long time when they see the
simple problem of a little filler to be
dissolved under the eye
nothing is simple if you do this long
enough and you see
enough people let me know your thoughts
what have you had done
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