August 23, 2019

We are used to thinking if you use hyaluronic acid, you can get out of any situation with a quick blast of the magic enzyme hyaluronidase that will chop up all the offending product and restore your patient to their untreated state.

Unfortunately, that is not always the case, and this situation can be extremely stressful for practitioners.

Fear of getting sued, reported to governing bodies, or being attacked publicly for a complication you cannot solve, keeps many good practitioners awake at night.



Defining the Complication: 10 year old filler case study

It’s vital for clinicians to understand how to differentiate between different types of complications at various points along the pathological process.

Janey had lumps of dermal filler in her lips, nasolabial fold and cheeks for over 10 years.

In this case, hyaluronidase could have been an effective treatment if used at the right time, but unfortunately, it was left too late.

Nodules can become resistant to hyaluronidase, and in this case, the patient was left with disturbing nodules for 7 years.

These caused her a great deal of mental stress.

She was partly worried that they have caused her an autoimmune disease and imagined that she would have to have invasive surgery to solve the problem.

Thankfully for her, the end of a 10-year ordeal was only a few minutes away.

what happens id hyalase doesn't workIn order to end her ordeal, I manually extruded the old dermal filler.


If Hyalase fails what can you do?

Though these types of complications are relatively small in number, the variation in presentation is at different points along the process can make it difficult to know how to resolve a problem.

Here are three methods you could use & some of the risks they can impose:

  1. It can be best to leave nature to take its course.

– However, this sometimes makes things permanently worse too!

  1. It may be effective to inject drug treatments

– If you time this wrong, it’s a risk you create with potentially no benefit.

  1. Mechanically attacking the problem

– A problem with mechanically attacking the problem is it can cause side effects with no benefit; however, it could be the only thing that works.


The problem is often about timing and knowing the story of each pathological process.

There’s a lot to learn, but once you know it, complications no longer keep you awake at night.

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