How to fix overfilled fillers at my cheeks?

Sorry to hear that you are not happy with the results of your cheek and undereye fillers for your undereye circles. This can be quite common (particularly with inexperienced or unlicensed injectors). I have personally encountered similar cases of overfilling, which sometimes require a bit of finesse to resolve.

How to fix overfilled fillers at your cheeks?

There are quite a number of ways to fix overfilled fillers such as:

1. Manual reshaping / Massage
2. Hyaluronidase injection
3. Radiofrequency
4. Physical removal via excision or extrusion

The method we choose would depend on various factors in each individual case, such as:

• Degree of overfilling
• Location of filler
• Depth of the filler
• Patient's natural facial shape and pre-existing asymmetry
• Whether complete removal of all the filler is desired or just adjustment

My approach to overfilled fillers - Analysis is Key

First, I would need to analyse the facial structure with the patient using 3D imaging. This allows the patient to see their own face as others would. Any filler procedure or correction needs to take into account the patient's natural facial asymmetry, which is more obvious on the 3D model. I would then identify any areas where I feel the filler placement is sub-optimal and also seek the patient's feedback on which area they feel is unsatisfactory.

Example of a 3D model produced using Vectra with which patient discussion can be carried out (source).

Which correction method to use?

• Nothing: Sometimes it doesn't look so bad after 3D analysis
• Minor asymmetry or irregularities: Careful and judicious repositioning sometimes suffices. Works better if tried soon after filler placement. Please leave this to your doctor, don't try to do it yourself!
• Hyaluronidase Injection: An enzyme that rapidly dissolves hyaluronic acid based fillers (the majority of fillers) and agarose-based fillers (such as Algenesse). Does not dissolve other fillers such as Ellanse, Radiesse, etc, but it may allow these to spread out making them less obvious.
• Radiofrequency/Laser: Produces heat to breakdown filler material. Transcutaneous radiofrequency where the probe is placed on the surface of the skin may smooth out the contours for superficial fillers, but may not be able to penetrate deeply enough through the skin to dissolve cheek filler, depending on the placement of the filler. Injected radiofrequency or laser using an insulated probe or laser fibre can directly penetrate nodules of filler to break them down.
• Physical removal using excision or extrusion: Used for nodules or well-circumscribed areas of filler, this involves physically draining the filler, more commonly used when the filler is not vulnerable to hyaluronidase injection.

Do see a doctor who will be able to advise you on the best course of action to take to resolve your puffy cheek.

Hope this helps!

Warmest regards,

Dr Wan Chee Kwang

References:

1. Cavallini et al. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J. 2013 Nov 1;33(8):1167-74.

2. Cassuto et al. Advanced laser techniques for filler-induced complications. Dermatol Surg. 2009 Oct;35 Suppl 2:1689-95.

3. Wolter et al. Removal of the permanent filler polyacrylamide hydrogel (aquamid) is possible and easy even after several years. Plast Reconstr Surg. 2010 Sep;126(3):138e-9e.

Some fillers like hyaluronic acid, tend to absorb water within one week of treatment, causing some concern in patients who may not be aware that this may happen. The swelling is generally more obvious in the morning and can be improved by gentle pressure or a mild cold compress.

For cases in which there is overfill, hyaluronic acid fillers such as Juvederm, Belotero, and Restylane can be dissolved by a doctor using hyaluronidase (a naturally occurring enzyme found within our skin). When hyaluronidase is injected into the affected areas, it breaks down the hyaluronic acid rapidly, helping to correct the overfilled areas.

I would recommend going back to the doctor who did the treatment for a thorough assessment.

You can find more information about dermal fillers in my article here

Cheers,

Dr. Terence Tan

You could dissolve the fillers if they are reversible. This can be done with hyaluronidase for many types of fillers.

If not grossly disproportional, you may also consider using some radiofrequency devices to tighten the skin or "diffuse" the fillers.

I would recommend the above remedies in the hands or supervision of an experienced aesthetic physician only. Hope this helps!

You should get a review and follow-up with the doctor who did the fillers for you or get a proper assessment done by an experienced aesthetic doctor. If the fillers were done recently, it may still be amenable to manual massage or reshaping to correct minor asymmetry or lumpiness.

If the fillers were done some time ago, one way is to use radiofrequency energy devices to tighten the skin around the fillers to correct minor asymmetry and lumpiness, as well as to increase degradation and break down of superficial fillers through thermal energy.

Also, if the fillers used are hyaluronic acid fillers, hyaluronidase can be injected to dissolve them. However, hyaluronidase does not work for collagen stimulator fillers like Radiesse and Ellanse, and agarose fillers like Alginess.

In such a scenario, may I suggest a more prudent approach of combining gentle massage and radiofrequency/lasers to even out the more "overfilled" side.

In my opinion, hyaluronidase injection should only be used if the above conservative approaches fail, because the amount of filler degradation on the "overfilled" side cannot be accurately predicted with hyaluronidase.

I would recommend that you see an experienced Aesthetic Dr to carry out the above procedures.

Hope this helps!

Best Regards,

Dr David Deng

Hi,

Have you compared the before and after pictures with your doctor? Sometimes, you may already have the cheek asymmetry to start with.

If indeed it is an issue of the fillers being excessive, or too superficial, hyaluronidase can be injected in the exact plane of the excessive fillers to remove them. This needs to be done very carefully as the fillers that were placed in the right plane may be removed as well if too much hyaluronidase was injected or if they were injected in the wrong plane.

If that doesn't work, then radiofrequency treatment on the area will also help to heat the fillers up and accelerate their breakdown by your skin as well.