Injectors Guide: Hyaluronidase for Correction
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- čas přidán 29. 08. 2024
- A resource derived from all the latest data on how to correct unwanted filler outcomes on the face.
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All the best,
Daniel Julien, NP
![CAN SALINE REVERSE FILLER? Is saline an alternative to hyaluronidase? [Aesthetics Mastery Show]](http://i.ytimg.com/vi/bfOksGi1FLg/mqdefault.jpg)
Serious about becoming an injector? Do you want to master techniques and strengthen your business? Be sure to visit my Patreon page for both full length medical aesthetics tutorials and entrepreneurial strategies to take your practice to the next level.
⭐www.patreon.com/danestheticsmedical
⭐Instagram @danestheticsmedical
**I got my filler dissolved** I did a lot of searching about dissolving filler and much like everyone else, theres a lot of scary and bad stories out there. I was really torn on getting my filler dissolved or not but I was confident in my doctor and I took the risk and got it done. I had had filler 4 times in 4 years (2 syringes June 2019 and 2 October 2022). I felt overfilled and puffy and wanted to look "normal" again. If you go to RealSelf its full of terrible reviews but I will say, I think a lot of it is unrealistic expectations. Here me out, before I got filler I took photos of myself so I know exactly how I looked 4 years ago. Getting filler dissolved you have to also understand you will look different in 4 years... I think people dont understand that part. Heres my experience: She pricked me a total of 5 times (3 one eye area, 2 the other) and it burned like hell for a second but then it was over. She didnt massage it or anything (I had other filler I didnt want dissolved yet so she maybe didnt want to spread it). She said it could take 3 days to fully dissolve everything. I had to sign a waiver and that waiver does mention the rumor of it possible dissolving good HA (like all the horror stories but many doctors say it comes back soon after). The day it was dissolve I did feel like it was a little "deflated" looking but I plumped back a couple days later. I might not even had been "deflated" but all the reviews and scary stories prepare you for that affect so maybe I thought it..I am happy with the results. I look different but I am not who I was 4 years ago and I think its approprite for my face/weight/age (29 year old). My under eye veins are more apparent but I mean, theres no filler there to maybe cover them? Regardless, I am happy I took the chance and I will be going back to get all the rest of my filler dissolved about 3 weeks after this was done. If you have questions, I would be happy to help and provide pictures, if needed.
How is it going? Are you still happy you had it done? I’m considering it but put off my the online horror stories and people claiming they’re deformed for life etc.
@@MissUltimaThule I'm happy! I went back for another session. I'm going to have another one because I still know there's filler in some areas. Were taking a slow approach to it. I have to get used to looking different but it's natural and I'm accepting that over the distortion filler gives your face.
Im gonna getting my lips dissolved, im devestated. Can I write to u anywhere?
@jd jd same!!!! I'm terrified by all the horror stories. I hate the way this is making me feel. It consumes all of me all day!
@@mariadpolanco5744can totally relate!
It is important to note some related in vitro studies, such as those of Marazzi and colleagues, evaluated the role of hyaluronidase in skin and soft tissue vitality [53]. High concentrations of this enzyme have been reported to inhibit skin vitality. It has also been mentioned that concentration-dependent hyaluronidase toxicity is the cause of postoperative periorbital inflammation after cataract surgery after regional anesthesia.
thank you for this video! was very helpful. not alot of info on how to use hyaluronidase out there.
You are an amazone Doctor!!! I wish i can go with you! Since i have a bad TT filler 😢
My name is Ashley, I am 27 yrs old, and a few days after seeing hyaluronidase degrade my entire face from only having less than 0.5ml of voluma for a scar, I had suicidal thoughts for the first time in my life. From being active, finishing my third degree, and enjoying life, never experiencing a drop of mental health issues, I lost everything shortly after hyaluronidase. Yes, not everyone has a bad reaction, but if there are hundreds of realself reviews, forums, and over a thousand members in a FB group dedicated to hyaluronidase damage, then the medical community needs to take action, and stop putting greed over safety, and actually do more research on the application of the human body.
How long after did you see the damage
Hi where did you have it injected x
Your reply and more info required to act progressively on this. What do you mean with "degrade my entire face"? In which area of face hyaluronidase was injected and how much?
Interesting! What if there is just a small bump you’d like to bring down on the lip but you’d like to attempt to preserve the rest of the filler?
Dear God thank you for this video! You've saved my tear troughs!!!! Please keep doing these videos and showing us the measurements! ❤👄
UR LITERALLY MY HERO UR VIDS ARE SUPER EDUCATIONAL UGH LOVE IT
tks for the informative video. you test for hyaluronidase sensitivity. we have not tested patients for hyaluronidase sensitivity. but, have used it to reverse fillers. wondering, how often do you have someone sensitive to it. do you find a difference in sensitivity between human vs bovine hyaluronidase?
i got my undereye filler dissolved today , this video is a big help, i told my doc to put just 1inject both undereye , it was small amount to just dissolve the tyndall effect , im gonna update what will happen, i hope its not gonna get worse, and im gonna have my collagen drip maintenance tomorrow,
Did you have it refilled?
@@christylynn451i didnt, because sooner or later tyndall effect will happen again, so i will never try fillers again, fillers are good at first but when tyndall developes it doesnt look good,
How did it go ????? I have a bit of under eye filler left and totally hate it. But I’m so scared to dissolve it.
omg Dr, you'r the best!!! love u andd ur videosss!!!! thanks
I need this ...thanks for the info..
Me too! Xo!
Thank you for the very informative video! Just a quick question, is it a good thing that lidocaine causes vasodilation when you're trying to dissolve the filler, if so how come? Thank you :) !
It’s a good question. Vasodilation could help it dislodge, but where would it go? In theory it could push the blockage to the lungs, heart or brain. It’s something to think about. Personally I just use hyaluronidase without lidocaine
Does this melt the fillet or actually get rid of it?
Thank you for these informative, well put together videos. Would you provide some guidance in terms of how much hylanex should be available at all times in an aesthetic practice?
I keep 5-6 10ml vials of 150units per ml. Replace them every 6 months.
Thank you!!!! Necessary information
Hi, Thank you for the informative video. Can you please comment on the possible risks associated with Hyaluronaise? There are some anecdotal reviews of people who have been injected with it and who have experienced volume loss in their natural tissue. Have you seen this in your practice?
If you flood the area with hyaluronidase, it can dissolve some of your natural HA. That said, your natural HA will always restore itself. It can take up to a month, however.
@@danestheticsmedical absolutely not true. tissue doesn't magically regenerate. holes, dents, saggy skin will be the permanent result www.drugs.com/comments/hyaluronidase/
@Hot Toymania do you mean getting it dissolve will cause all these symptoms. or keeping the filler on your face can cause the symptoms ?
I got my filler dissolved under my eyes over 8 months ago and now I have horrible hollows that I never had before so the area never recovered from the removal of the filler so l've decided to go for lipofilling,
But isn’t that why you got them filled in the first place? I keep reading people saying they have hallows under their eyes after dissolving but I’m confused if that’s the reason for filling, why wouldn’t they come back?
one dr put too much filler under my eyes. and it was terrible and because covid19 he could treat me only few month later, he dissolved it and my skin is saggy. by the way few years after fillers i did back in 2017, i feel like my face stretched and loose skin nose , jawline, cheekbones. im just 24, skin isn't really go back to who you were. some filler even last years and you can feel it under the skin even if the dr say it lasts only 6 month tili 18 month...
Hi Dan. Thank you for your wonderful videos. They are a great help! I have had a bump on my tear through for a long time (old filler I think) and decided to dissolve it. I used a very tini amount of Liporase. The bump is almost gone but I was left with a droopy / hollow eyelid. Would I need to do fillers in that area? Thank you as always!
Fernanda JB Hi Great Question. If it bothers you that much then yes a small amount of fillers to the tear trough will fix it. But it’s about a 50% chance that the same problem will occur within the next year.
Thank you so much!! This was really helpful. You saved me!!
Love hearing that!
thank you soo much, very helpfull 😀
I got 800 units in midcheek is it too much? small deposit. Now i have huge volume loss and skin laxity 3 months after hyaluronidase.
Hi there! Thanks for this informative video...quick Q, what about trying to dissolve a small lump in the lips. Would you use 0.05mL of hyaluronidase? I've heard of some providers diluting with lidocaine to make it more comfortable for the patient. Any thoughts on that? If you use that in your practice, what ratio? Thanks in advance!
Sure that could help. Sorry fo the delay!
And how to restore the skin after hyaluronidase injections? His fabric became thinner, the corners of her lips lowered because of this. How do I fix it?
What about dissolving nose filler? What are the major risks with that?
Dan, very informative. Thanks ! If I'm injecting only 0.1 cc in a tear trough bump, do I still need to do a patch test ?
For non urgent cases, yes you should perform a patch test.
Hope this helps.
All the best,
Dan.
@@danestheticsmedical Even if I'm injecting 0.1 cc ?? The Vitrase patch test is way more than the treatment dose
Ed Cubberly Hi Ed. I get it. The risk is you’re injecting closer to the eye and mucous membranes. If they have a reaction it would likely be less severe in a distal location.
@@danestheticsmedical when you speak 5 units they are 5 of a dilution 1500 U in 10 ml of saline? That's about 150 units per ml. So for dissolve under eyes it's 5 unit of this? I must dissolve my fillers but the doctor say that 1500 U are dissolved only in 4 ml of saline and after he put about 75 units in 3 diferent points in each eyes, so it's that too mutch?
@@danestheticsmedical Hi Dan thank you so much for this video :) Question please: I got filler on my cheekbone and now theres too much of it. Can it be removed half way and not the whole thing if not put too much? i got less than .5 ml in that area how much hyluronidase to removed half of it? if i got botox in the crows feet can i do hyluronidase the day after and the botox not be removed? Thank you hope you can answer my questions? :)
Thanks for all these great videos. I have shared many of your videos with an aesthetic group in Facebook im member. Do we need to do the patch test for hylenex as well? its human recombinant and not bovine.
Saghy Motamedy Thanks!
Yes, you should.
What group is it? I'd love to join!
How long can we keep the mixture in the fridge???
hi doc, is collagen drip good after doing this hyaluronidase ? i am just scared about this enzyme, and is vitamin c, collagen booster drip helpful for skin to avoid further damage of that dissolver?
Hi! I got my fillers dissolve on my lips about a week ago. Now almost 7 days later my lips got itchy and swollen! Is there a possibility that o got an allergic reaction almost 7 days later? After I my lips felt perfectly Normal the first few days? I’m trying to figure out if that’s normal. Please help!
How about doing a masseter botox at same time?
How do you get rid of filler that won’t dissolve? My filler has only gone away in small amounts after dissolving and it’s been 3 years.
How about on the nose? I had red on my nose tip .what is the best i cand do ?
How much units do you use for asymetrical peroral region after nasolabial and marionate filler , whats the depth of the injection , the doctor tried to massage the filler(too much ) , but ended up distrubiting it all over the peri oral area and making it look more assymetrical , thank you
great video!!
Thanks Hannah!
Hello, thanks for the video! If a patient is allergic to Hyaluronidase but for example is having a VO/VC; how do you proceed with this? Please! :)
Hi, this is very tricky. There’s no right answer here. If a client is truly allergic to HYAL, I would have had a real conversation about the risks of an occlusion before offering fillers.
If that conversation was missed, here are some options in no particular order:
1. Give hyaluronidase and monitor for an allergic reaction. If signs of anaphylaxis, administer epipen injection and drive them to ER. With a risk of death d/t anaphylaxis.
2. Don’t use Hyaluronidase and risk a scar.
There are other alternatives in between. But they have their own risks and may not cover you from your college.
3. If you’re uncertain of what to do. You could write up a consultation note and have a vial of hyaluronidase prepped in a cooler (Many ER’s don’t have hyaluronidase in stock). Give both to the Pt and advise them to go to the ER. Tell them to give both (note and HYAL) to the triage nurse.
The note should indicate the reason for the referral (occlusion) & the allergy risks and benefits associated with hyaluronidase.
Essentially you are passing the decision to another provider here. That ER doc won’t be happy with you. But at least the client is in a controlled environment if things were to go sour.
All the best,
Dan.
What about volite skin booster its been 2 days i m left with small bumps in all injection site i dont have any pain or inflammation but i am afraid to try hyaluronidase to reverse it....can you recommend anything
If an injector uses 120units te the first time and about the same units the 2nd, is that an overcorrection? I’m considering dissolving my lip filler a 2nd time, but I’m not looking to dissolve as much as the fist time.
If i get less than 1 syringe of voluma, can i have it disolved even though it isnt much? Also when do your masseters grow back visibly after masseter botox? 1 month after having 22 units each side masseters i now have jowls and look older.
Hi, thanks for the video ! Its normal to observe redness and swelling in the zone before the hialuronidase inyection?
Do you mean immediately after injecting? Yes that can happen
It’s a one to one ratio for mixing in the saline yes?? So 7 iu H into 7ml of saline yes??
Hi i use hyloronic asid filler in tear trough know it is goibg wose too much puffy eyes what to do shuld i use hyloronicdies and how much unit shuld i use
Hi Dan, I was overfilled 2 days ago and I look like a balloon. Could we chat please? Please let me know. Thank you!!!
Hi after how long can you see result?
I did it today, I only wanted to remove the migrated filler in my upper lips and lower lips. She gave a couple of injections. I hope it doesn’t remove all of my own collagen . Love to see you respons.
How did it turn out??
@@shevy1227 everything is gone 😂
How much saline should be added to hylenex(150u)?
Yo! Dan, My computer audio not so good. Did you say 15 or 50 U per quadrant in the lips?
15 units per quadrant
Can you write me the name of the product? Is it dilution or i must do it?
is this safe for chin filler?
What happens if the dosage for emergancy it's used for corection? My face is melting. Are we ever gonna be back to normal or out tissue is distroyed forever?
It usually does come back to Normal. But I’m starting to advise caution on placing too much hyaluronidase in the mid face. Many people are complaining that the integrity of their skin changes after dissolver and lasts for several months.
How are you feeling now?
@@munchkinlittles7031 i m still experiencing so many side effects, from very lax skin and tissue on all body to swollen face in the morning to melting one in the evening. Lost all my shape, is not me anymore
@@alinabratu2458 Have you joined the HYA DAMAGE group on facebook? over 300+ ppl in that group with the same symptoms as you. Stay strong
@@alinabratu2458 ?
Hi doctor some people have complained about volume loss after hyalase that their face is a lot more hollow than before it dissolves more than filler does that happen to people who just have a reaction to it or for everyone? I need peace of mind as I’m about to dissolve all my filler. Thankyou
www.drugs.com/comments/hyaluronidase/
Thanks for this video. How much is too much Hylenex? I had 1 ml of Restalyne lyft put into the bridge of my nose...after a couple weeks of headaches, pain and redness, I wanted just a small amount of the filler dissolved to reduce the pain. My injector said she administered a small amount of Hylenex (0.2 cc Hylenex + 0.4 cc saline for a total of 0.6cc diluted solution). I am confused as to whether I got 0.2 cc or or 0.6 cc Hylenex. Is this a little or a lot of Hylenex? I noticed that my upper cheeks and under eyes have less volume and darker circles with more wrinkles now (where i have never had any filler). I can't explain this obvious volume loss other than 3 months ago getting Hylenex and still no improvement. Now I am searching for a solution for my under eyes and upper cheeks
After dissolving to ur symptoms like headaches go
It also dissolves your natural hyaluronic acid on your face so that might be the reason you're losing volume elsewhere
How much hyaluronidase do you use on cheeks?
Hi Dan,
In regards to lip correction, how long after dissolving the lip filler do you wait to re-inject with filler? and any post care instructions, ie no exercise for 24hrs?
Tiffany Marquez If they’re in a rush, then 3 days. But ideally you should wait two weeks to make sure everything is healed up.
@@danestheticsmedical so do u still recommend the 2 weeks?
Hi. Can you write me the tipe of ialuronidasi that do you use please?
Thank you Dr. if I was injected 3CC of volbella under each tear trough, what is your best recommendation for dissolving all of it? How would you treat a patient who needed this dissolved? Thank you!
That depends if you want to dissolve all of it. If so, then the same amount (0.3cc)
@@danestheticsmedical Thank you Dr. I was just making sure that there is no other specific way to dissolve Volbella (with what I read about it being cross-linked with Vycross technology, harder to dissolve, etc.)
I got juvederm injection at plastic surgeon but I felt lump of filler on my cheek, is that mean he injected in superficial fat ? feels bad I feel it is like a small pall, I can t see it but only I can feel it. I called him he said just wait 2 weeks until the inflation and edema gone then I can massage it and distribute the filler equally on your face...is this correct? I have feeling it is not the case?
How did it go?
Is it possible for someone to have no reaction or a small reaction to the patch test and still have a severe reaction to the hyaluronidase?
Because the patch test requires a smaller amount then you would use in case of emergency, I think.
If they have a rash or hives around the patch test, then yes they can have a much stronger reaction when injected in the face.
I had cheek filler a month ago. It left white lines in both sides of my face. The lines are getting wider and my injector doesn’t want to dissolve my filler. Should I consult with a different plastic surgeon? I’m embarrassed at how bad I look. Thank you
If you’ve already given your injector a chance to correct it and they can’t, then you always have the right to a second opinion
Thanks so much Dan! where do you purchase your hyaluronidase from? Do you keep an epipen handy? and do you keep atleast 600 units handy at all times?
Teena Lukose You’re welcome. We purchase our hyaluronidase from a compound pharmacy.
I keep six 10ml vials of 150iu/ml.
@@danestheticsmedical Is it cheaper to get the generic ?
Hi, a Dr used a product labeled with 1500 iu to be mixed with saline. The Dr applied the whole vial divided in my lips, nose and jawline, was the amount excessive? I’m tempted to sue him, I thought each vial was 150 units max.
i got 800 units and my dr said its the smallest dose. now i have volume loss. whats your experience?
what if u failed the patch test? how do u get rid of the disaster lumps bumps etc?
Probably have to wait till your body dissolves it itself 🥴
If only 70 units used, what to do with the rest ? Cant freeze in the solution right?
Ours is pre-prepared. It’s good for one month once opened
@@danestheticsmedical thanks for fast reply!
But are you aware about the hylaronidase monequle itself and freezing down the mixed solution after? For example some peptides this is alright, some its not ok to refreeze over and over, and hcg for example you should not reefreze at all. Is hylaronidase sensetive like hcg?
If one did HA im into the muscle, and missed the spot and had it travle all around the body to chest/legs/back, is one at risk for stroke/clotting? Tought its ok cause HA is natural, but I saw a study worry about this and how it can block vessles. Toughts on that?
One more, do you ever have people getting fatigue or dizzy the days after?
I did the cavitation device to remove the ha, and people call that machine safe ... but it DESTROYED me for 1-2 weeks, like i was drunk. Wounder if im sensetive to hylaronidase also...
please ,, how much normal saline you use for dilution ?
For hyaluronidase? It’s pre made
Hi Dan. For 1500iu is equal to how many cc if added with saline solution? Is it can added with normal saline or must be use sodium chloride if use to dissolving ha filler?
Mortal Instrumentz 100 units equals 1cc.
All of our hyaluronidase is premixed and prepared by a pharmacist. I would recommend asking your local pharmacist.
Thanks,
Dan
Do you proceed with a patch test even if the client has a shellfish allergy?.. have read it shouldnt be done but what if they had a VO? Thx
Great Q. More and more providers are saying no. But I just did a patch test on someone with no shell fish or fish allergies, and they reacted!
@@danestheticsmedical oh my .. what would you do if they had a VO?.. and has a shellfish allergy?.. is there one product that wouldnt effect them?.. thankyou for replying x
I would so appreciate your opinion on the following: 2 years ago I tried lip filler but along with hating the result started to develop lumps and so I had it dissolved. The doctor seemed to use a lot of hylase and since then I have been struggling with dry lips. Could my native HA have been permanently damaged, or is this coincidental?
Likely coincidental. Consider getting PRP to your lips to restore some natural collagen!
www.drugs.com/comments/hyaluronidase/
Can you mix a small amount of lido with the Hdase to decrease the stinging?
Yes you can!
@@danestheticsmedical how much lidocaine do you recommend?
How soon can you inject HA in the same spot as you dissolved it in?
Cory Lynn in theory, within 24 hrs. But I always wait three days to make sure whatever I put in won’t be dissolved.
Would a peanut allergy prohibit lip fillers from being dissolved? Thanks :)
If it’s not an emergency perform a patch test first on everyone. If it’s an emergency, no patch test is necessary.
Peanut allergies are not linked to hyaluronidase allergies.
All the best!
Dan
Hi Dan, thank you for your very informative videos! Question. If I would like to dissolve cheek filler (Juvederm XL) for overvolumized cheeks, how much would I use, and could I dilute the 150 per ml with saline and use a 25 gauge cannula to fan the product around the area bc it is larger? Or would you recommend micro injections with the 150u/ml with a bd syringe and massage?
Hi Tammy, In Canada our 150ml/unit vials are already diluted with 10 mls of saline. So there’s no need to add more. Try and find out how much filler was used in the cheek. If they had one syringe, then use 1 ml to start. I would fan it using a cannula.
Regards,
Dan
Thank you
I’m am trying to find more information on using lidocaine 2% (40mg) in HCL 2ml with hyalaronidase diluted with N/Saline solution as I would want to make it as comfortable as I can for my clients. Is lidocaine a Vasoconstrictor? Would this work still with hyalase and be ok? As I’ve read articles that they still use both to help spread numbing in surgical procedures... I need to find correct dosages...
I use the following. 4mls hyaluronidase (150units per ml) mixed with 1 ml of lidocaine 2% no épi for emergencies. . Blend together. Lidocaine is a vasodilator. Lido with epinephrine is a vasoconstrictor.
@@danestheticsmedical If it is not an emergency, how much saline/lidocaine do you use to mix Hya? Thanks
Hi I just wanna know does it dissolve fillers completely?
Yes. Depending upon amount
Yes! But thicker fillers need more. And fillers that have been there for longer need more. And sometimes it needs to be repeated in order to completely dissolve.
@@danestheticsmedical thank you! The person that I got fillers done with put dissolving solution and it’s still not going and I went there to get it dissolved 3 times would you know why?
Did we need to use lidocaine cream on lower lid before dissolving?
I inject my patient only cheek filler ...but..then...a swelling lower eye lid happen....so...where can I inject hyuloronidase to dissolve filler...
Inject cheek or lower eye lid??....thanks dr.
Lidocaine won’t prevent swelling! It’s a personal choice to use lidocaine or not.
Thanks for the info. I think I wanna marry you already. Haha
Lizzy Guerra haha!
If i use hyaluronidase to remove the acid hyaluronic i could get a worst result? Help me pls
What about if too much hyaluronidase destroys your own HA and tissues? How long it takes to renew? Thank you.
It can take up to one months for it to fully recover.
Thanks for the terrific question.
Dan
www.drugs.com/comments/hyaluronidase/
im 3 months after and still is not recovered, its much worse. @@danestheticsmedical
It will literally ruin your life please don’t do it
Hi i am considering dissolving my under eye filler. Why do you say it can ruin your life?
Im very scared of this procedure and not sure what to do.
The filler caused me for a malar edema. This edema is not so big but very irritates me, therefore i am considering what to do, if to dissolve or just wait.
The Real self stories are very scary is well.
How are you now? It injured me too😢
If you're a spa, please change that background =)..😘