I administered Juvederm ultra in the nasolabial area. My patient complained of lumpiness 24 hours post injection. Can anyone please advise on what to do?

Lumpiness can be somewhat relieved by firmly massaging the affected area. The injector must wear nitrile gloves or vinyl gloves, with his or her thumb inside the clients mouth while the other massaging the area of lumpiness. . Or you can inject the affected area with an antidote, hyaluronidase, which breaks down and resolves these lumpy hyaluronic acid formations!

How much do you inject into the site with the antidote? As you inject, do you wait a while before massaging or do you do this straight away?

You can knick this lump with sharp 11 blade and squeeze it out.

If it is only 24 hours after injection, I advise administering stronger massage on the affected area. Area can be swollen and red for 48-72 hours. If you want to use hyaluronidase to reverse the effect, you can inject 2 units. But beware that you can't inject any dermal filler in the next 3 weeks in the same area.

Don't jump on the antidote as massage in my experience works most of the time. Ask the client to massage daily and have a weekly visit for you to check the progress of the condition.

I also tell my patients to massage the area and have them follow up at 2 week intervals. Reassure them that the lumps will go away. I have never had to dissolve the product.

I use hyaluronidase as a LAST resort. In my 11 years of practice, I only used it twice. Massage is best. The product smooths out very well with light massage at treatment time or firmer massage a day or two (or seven) days.

I have a client who had a lump in her lip after injecting Juvederm Ultra that didn't really resolve with massage - she still has it after one year! Could this be scar tissue that needs to be cut out? Her lips still appear augmented so I'm hoping it's still filler that has not yet been broken down naturally. Thoughts? Would you even try hyaluronidase after this long?

Be cautious. Massage it first. If it does not resolve after 2 weeks then you can think about using the hyaluronidase. This could be localized swelling related to an injection site or many other possibilities.

How quickly does hyaluronidase's effect kick in after injection? Is 2 units every one cm the regime for any part of the face that has been injected with filler? Will the hyaluronidase have had its full effect at 3 weeks post injection and is it possible to bring client back for more hyaluronidase if necessary after 3 weeks?

Hyaluronidase starts working almost immediately and typically, its full effect is visible within 2 days. The international guideline is to see your patient 3 to 4 days later and if necessary one can to re inject. If you are trying to break a lump of filler then 150 U directly into the lump should be enough but if you want to remove filler from the entire lip area the best approach (for me personally) is to inject the hyaluronidase with a microcannula (between 150 to 300 U) dispersing the hyaluronidase throughout the entire lip area. Please be wary of the potential of acute allergic reactions that may (rarely) lead to anaphylactic reactions. Hyaluronidase will break the patient’s own HA down but our bodies regenerate its own HA every 24 to 48 hours so any ‘extra’ thinning is reversed within that time period. I hope the above has helped

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