HA naturally exists in our bodies—in the skin, joints, and even the eyes—and is gradually metabolized after injection. However, in some cases, fillers may persist longer than anticipated, leading to aesthetic concerns or complications. Here, I’ll share why this occurs and how I approach managing such situations in my practice.

Why Hyaluronic Acid Fillers Persist

The longevity of an HA filler depends on its thickness and viscosity. For instance, thicker fillers like Juvederm Voluma, designed for areas with less movement such as the cheeks, can last up to two years. Softer fillers like Restylane-L or Juvederm Vobella, used in high-movement areas like the lips or under the eyes, are typically metabolized more quickly.

However, certain factors can prevent fillers from breaking down naturally:

• Encapsulation: Sometimes, the body forms a capsule around the filler, treating it like a foreign material. This can be due to surface bacteria introduced during injection or an immune response. Encapsulation can stop the natural breakdown process, leaving fillers in place for extended periods.
• Migration: Fillers may shift to unintended areas, such as from the temple to the brow or from the nasolabial fold to the cheek or lip. This displacement can cause aesthetic concerns and may also lead to encapsulation.
• Biofilm Infections: A biofilm is a low-grade bacterial infection that can form around fillers, causing intermittent swelling and inflammation. Biofilms are challenging to treat because the bacteria reside within the filler material, which lacks blood supply.

My Approach to Managing Persistent Fillers

When addressing persistent fillers, I aim to restore natural anatomy and resolve complications. Here’s how I approach these cases:

1. Dissolving Fillers with Hyaluronidase: Hyaluronidase, an enzyme that naturally occurs in the body, is highly effective at breaking down HA fillers, even when encapsulated or infected by biofilms. Administering it precisely into the encapsulated area allows the filler to dissolve immediately.
2. Multiple Treatment Sessions: Sometimes, additional treatments are necessary. For instance, patients who have had fillers in areas like the cheeks or eyes for years may require multiple sessions to address both superficial and deep filler deposits.
3. Specialized Expertise: As an oculofacial plastic surgeon, I bring a deep understanding of facial anatomy, particularly around the eyes. My training in ophthalmology and reconstructive surgery equips me to handle complex cases, especially when fillers have migrated or are situated in deeper tissue layers.

Dispelling Fears About Hyaluronidase

A common concern among patients is whether hyaluronidase will dissolve their body’s natural HA, leading to a hollow appearance. In my experience, this is not a significant issue. The body continuously replenishes its natural HA, ensuring long-term balance and health.

Conclusion

Persistent HA fillers can be effectively managed with the right expertise and tools. Whether caused by encapsulation, migration, or biofilms, solutions like hyaluronidase allow us to restore natural anatomy and achieve the desired aesthetic outcome. If you’re dealing with filler-related concerns, it’s essential to consult a qualified and experienced physician who understands the intricacies of facial anatomy and HA fillers.

FAQs

1. Can encapsulated fillers be treated without surgery?

Yes, encapsulated fillers can often be dissolved using hyaluronidase, avoiding the need for surgical removal.

2. Will dissolving fillers make my face look hollow?

No, hyaluronidase targets the filler specifically. Your body’s natural HA replenishes over time, preventing long-term hollowing.

3. Why do fillers sometimes migrate to other areas?

Fillers can migrate due to facial movement or placement in areas prone to displacement. This is why proper technique and knowledge of anatomy are crucial for injection.