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The most popular facial fillers are Restylane, Juvederm, Voluma, and Belotero. These fillers are similar in that they are all made of Hyaluronic Acid, which delivers a high level of safety and efficacy in facial volume enhancement. Sometimes, though, facial fillers can have complications and that is one reason patients seek the expertise of Los Angeles plastic surgeon Dr. Raffy Karamanoukian. He is a leading expert in facial filler complications and has the experience to repair unwanted facial fillers that are causing problems.


Common problems with Hyaluronic acid facial fillers includes overfilling, underfilling, asymmetry, lumpiness, granuloma formation, chronic swelling, allergic reactions, and bumpiness. If you are having problems with Restylane, Juvederm, Voluma, and Belotero injections, Dr. Karamanoukian may be able to repair the issue with lasers, injections, reversing-agents, and surgery. 


Another common problem seen in our Los Angeles plastic surgery office is filler rejection and granuloma formation with permanent fillers such as Biopolimero, Biogel, Silicone injections, Artefill, Artecoll, Bellafill, and silica. Dr. Karamanoukian is internationally renowned for his expertise in the management of permanent facial filler complications; especially silicone of the lips and buttocks.  Liquid silicone injections that have been placed in the upper or lower lips can cause pain, itching, burning, and swelling that can only be resolved with the surgical removal of the silicone material. Dr. Karamanoukian has successfully removed silicone and other permanent fillers from the face and lips. 


Hyaluronidase is an enzyme that can dissolve hyaluronic acid, the main ingredient in facial fillers such as Belotero, Juvederm, Juvederm Ultra, Perlane, and Restylane.  Dr. Karamanoukian uses a Hidef Hyaluronidase protocol that allows for precise injection of Hylenex or Hyaluronidase into the areas of granuloma or excess filler. Most commonly, the Hyaluronidase is injected to reverse Restylane, Restylane Lyft, Juvederm, Juvederm Ultra, Voluma, or Perlane in our clinic. Our office treats patients who have been injected by other physicians who are seeking an immediate remedy for botched fillers. If you have undergone a recent filler injection and are unhappy with the results, we would recommend that you seek early treatment to minimize longterm risks. Facial fillers can be reversed within a short period of time from the injection, but it is advised that you wait for the bruising and immediate swelling to subside first. 


Botched Lip fillers can cause the upper and lower lips to project anteriorly or to swell disproportionately. Overt swelling can be caused by incorrect placement of fillers, overfilling, or an allergic response to the fillers Restylane, Juvederm, or Belotero. In some cases, the fillers used are non-FDA approved such as Singfiller from China, or other types of hyaluronic acid facial fillers. Patients have also presented to our Los Angeles plastic surgery office with lip swelling from permanent fillers such as liquid silicone, biopolimero, Artecoll, or Artefill injections. If the filler can be proven to be a hyaluronic acid filler such as Restylane or Juvederm, Hylenex or Hyaluronidase can be carefully injected into the area to reverse the filler. If the filler is not FDA-approved, it may be necessary to surgically remove the injected material and resculpt the upper or lower lips to regain an aesthetic result. 


Q: What is Hyaluronidase? 

A: Hyaluronidase is an enzyme that is formulated to reverse hyaluronic acid based facial fillers that caus

e lumps, bumps, and asymmetry in the face. Dermatologists and plastic surgeons use Hyaluronidase judiciously to reverse abnormal results after hyaluronic acid facial filler injections. If you are faced with the Tyndall effect as a complication of facial fillers underneath the eyes, Hyaluronidase injections may improve your condition. 


Q: What are some facial fillers that can be reversed with Hyaluronidase? 

A: Hyaluronidase can reverse many types of facial fillers; all of which are formulated with hyaluronic acid. Examples include Juvederm, Restylane, Perlane, and Belotero.  If you have had facial fillers in another country, then there may be a good chance that the fillers can be dissolved with Hyaluronidase injections. 


Q: How many injections are needed to reverse Restylane or Juvederm? 

A: Clearly, the answer lies in the type of hyaluronic acid facial filler is injected and how much of it has been injected. Some patients will also have scar tissue, fibrosis, or granuloma formation from Restylane, Juvederm, Voluma, or Silicone that causes the Hyaluronidase injections to be less effective. Los Angeles plastic surgeon Dr. Karamanoukian is an expert in the field and can help you minimize the interval to resolution of the problem. 


Q: Can Botox be reversed with Hyaluronidase or Hylenex?

A: Hyaluronidase works best on facial fillers that contain hyaluronic acid such as Restylane or Juvederm. It does not work on Botox, Dysport, or Xeomin injections that have led to poor results. If you are having problems with your Botox injections, Los Angeles plastic surgeon Dr. Raffy Karamanoukian can help you improve results and restore symmetry to your face. Botched Botox can be fixed with judicious use of injections and time. 

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