Thank you for your question.
You stated your question without a photo.
And you state in your question that you feel that you need more hyaluronidase treatment
in order to address lingering filler in your nasolabial fold and marionette lines.
And that you’ve already undergone a few sessions that were conservative.
And you are looking for someone to do this additional treatment to address possible encapsulation
or allergy.
Well, I can certainly share with you a little bit about my experience using hyaluronidase
in situations that are probably comparable to what you are dealing with now.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Using the injectable fillers in the hyaluronic acid family whether it’s in the Restylane
family or Juvederm family is something I do a lot of in my practice.
And I’ve also had the opportunity to help people who come from many places who have
issues with the placement of fillers that may result in swelling, in possible inflammation
and as well as other issues that have to do with irregularities and the application of
hyaluronidase.
I think that when you think about the challenges of using fillers, we always have to be mindful
of the reality that fillers are a foreign body.
And that the body does treat a foreign body in times with something called encapsulation.
And that encapsulation can make it sometimes challenging for the hyaluronidase solution
to get to where it needs to go.
It means that it is not unusual to need multiple treatments.
We’ve routinely treated patients who come to us with under eye filler that resulted
in the formation of excess puffiness which required several sessions in order to achieve
the complete dissolution of the hyaluronic acid.
I think that at times, when people have hyaluronic acid in deeper tissues for extended periods
of time that it is a challenge to get all of it.
And we’ve had patients, one particular comes to mind, where she was very much aware of
the swelling of her cheek area.
And she had me injecting her frequently to the point where I would often wonder whether
or not she was over reading this, this was another health professional, so I gave her
some benefit of the doubt and she felt that it was working with each subsequent treatment
and I got to see the evolution.
In addition, we’ve had patients who also had issues with biofilm.
And biofilm is basically the formation of a response to bacteria that is living on top
of the injectable filler the way bacteria can live on top of an implant.
And so biofilm is often a challenging diagnosis and people may see it as either an allergic
response or some kind of inflammation that is a response to the foreign body effect of
the material.
I think that hyaluronic acid is generally very well tolerated as long as it’s appropriately
sourced hyaluronic acid like coming from the major companies that provide these fillers
whether it’s Galderma or Allergan.
I think allergies to this material are fairly rare.
That being said, hyaluronidase whether it’s for irregularities, whether it is for swelling
or whether it’s even for biofilm, I have found hyaluronidase to be a very useful tool
but that does require multiple injections as well as going into the different levels.
And so, we’ve had patients who have traveled all over the world and were treated in different
ways with antibiotics and steroids.
And biofilm in particular is very challenging.
But I think that we were able to make an impact with the use of hyaluronidase.
I think that certainly you are on the right track.
I would suspect that the amount of filler that was previously placed would be moderately
modest in those particular areas.
So I would be surprised if there wasn't any benefit or response to the treatment.
But I think that having more hyaluronidase injections done in short intervals I think
would probably make the most sense to be able to ensure that if there is any issue with
biofilm that would be addressed before there is the further growth of the bacteria.
So that probably makes sense and just requires multiple treatments when you think about something
that maybe, as you wrote, an allergy.
If it’s just encapsulation and if it’s just a space occupying issue, well usually,
1-2 injections can make a significant difference and the anatomy can come closer to its normal
baseline.
So I think meet with a doctor with experience with the use of hyaluronidase and take it
from that point forward.
And if it’s possible for you to get any photos of yourself pretreatment and of course
knowing the timeframe since the treatment, that’s always also helpful.
But generally speaking, I think a physical exam pretty much determines what level of
baseline can be achieved and the stability of that appearance.
So I hope that was helpful, I wish you the best of luck and thank you for your question.