Thank you for your question!
You state in your question that you had undergone Juvederm
injection for the nasolabial folds four year prior and that apparently you got very bruised
and you regret making this choice and you are waiting for the material to go away.
And now you state that four years later, there is still an elevation and you are asking if
the material is still there and would hyaluronidase be of value.
Well I can certainly give you my perspective.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
I use a lot of Juvederm and Juvederm Voluma and other fillers in my practice and I think
that there is an opportunity for you to maybe not only understand a little bit of the philosophy
that I come with in terms of my perspective on patient management of nasolabial folds
and my experience using this material and having patients come to me for second opinion
and revision.
So let’s begin with this concept of the longevity of fillers.
Fillers, when there are estimates provided to the lasting the longevity of the filler,
there is a certain direct correlation with the relative thickness or viscosity of filler.
The thicker the filler, the longer it tends to last.
And however, most if these estimates are based on placement at a certain level of the skin
and from actual clinical experience.
I’ve seen a wide range of time frames.
There are people who go through the injectable filler really fast and this is basically we’re
staying on the specific of hyaluronic acid filler which Juvederm is part of.
And there are people who have it for years to a similar story like yourself.
And I can say that my theory or a theory that many of us share is that the material being
a foreign material, even though it is well tolerated doesn’t require skin testing before
being placed, can become encapsulated almost in a way in some ways comparable to the way
a chin implant or cheek implant or breast implant becomes encapsulated.
The body can form become a capsule around the material which then prevents it from being
broken down.
So in situations like this where there is question, I do use hyaluronidase and I would
use hyaluronidase in a situation like yours.
I think it’s worth trying because the relative risk is low and you may actually finally get
back to your normal anatomy.
We have patients who had hyaluronic acid filler in their face and I’ve actually seen them
for several weeks to months at a time and I’ve injected hyaluronidase because the
material had gone to very different levels of the skin and they come back and say you
know there are a little bit stuff left here, there or somewhere else in their face and
they were always right.
I would also suggest that that in terms of your disappointment with your choice of the
nasolabial folds, you have to understand that a lot of times the standard philosophy about
facial aging and treatment has been I think stressing too much the chasing of lines and
the nasolabial folds is often a central focus or the parenthesis lines is often called.
The challenge is that the fold is in a way looks deep relative to the rest of the face
where there is also probably age related volume loss.
We do a procedure where we actually structurally restore volume in the face using traditional
hyaluronic acid fillers at the level of the cheek bones, jaw bones and the chin in a way
that restores volume and the fascinating thing is, I can do this and actually not put anything
in the nasolabial folds.
And although the depth will remain the same, once everything else is in proportion, things
look very good.
So I think that in our experience, it’s not about chasing lines.
Yes, there are places where there is value in softening lines but in terms nasolabial
fold, I’ve basically shifted a lot towards the restoration of the surrounding volume.
And even if we do place in the nasolabial fold, I’ve been very conservative because
you can imagine that or you can look and see that younger people can have deep nasolabial
folds but they don’t necessary look older.
There is a lot more facial aging then just the depth of these folds.
So as far as actionable decisions, I would suggest the you find a doctor you are comfortable
with a lot of experience with hyaluronidase and see what could happen in terms of dissolving
the material.
Hopefully it will dissolve and if it’s not dissolving, it might be residual tissue growth
from just the response of maybe the bruise or something like that but then that requires
physical examination and clinical determination by a qualified physician.
So I hope that was helpful, I wish you the best of luck and thank you for your question!