How to dissolve Belotero?

Another public forum question which I attempt to answer for fun.

Blue puffy bags after Belotero in tear trough + older Juviderm on inner orbit rim. Will Vitrase dissolve both at the same time?? Had bad reaction to Vitrase 2 years ago but can’t wait it out…it’s appalling.

Thank you for asking your question.  My answer is just an academic exercise in producing a discussion regarding a hypothetical situation.  My answer is not directed medical advice.  Please see your doctor in person for medical advice.

​​So how do we dissolve Belotero and Juvederm which caused blue puffy bags in the tear trough under the eyes?

​About the sensitivity to Vitrase issue:

​Vitrase isn’t the only hyaluronidase available in the USA.  I believe that other formulations are Hydase, Wydase, Amphadase and Hylenex.  All of them are animal derived hyaluronidase products except for Hylenex which is derived synthetically from recombinant human product produced by genetically engineered Hamster Ovary cells in a laboratory.  Because it is not derived from an animal and it is the human form of hyluronidase, there would be less reactions from it.  Consider using Hylenex.  This is what is available in my office.  ​For a patient with previous Vitrase reaction, I would try Hylenex.

​About dissolving both Juvederm and Belotero at the same time:

​Yes, Juvederm and Belotero are both hyaluronic acid fillers and will be affected by Vitrase, Hylenex, or other hyaluronidase products.  However, Juvederm will be a bit more resistant to dissolving.  Thus if a very small amount of hyaluronidase is use, the Belotero would dissolve first.

​Regarding the Bluish tint = Tyndall effect:

​That is probably from the Juvederm.  I have had the same problem before when using Juvederm in the tear trough.  But I still use Juvederm in that location but only for patients with thicker skin or darker skin.  I had to learn from some of these problems which I’ve also had.  I have only had one patient who reported a Tyndall effect with Belotero and thus I consider the Tyndall effect to be very rare with Belotero.

​Another possible suggestion – using dilute Hylenex:

​Much of what we do as doctors are considered off-label FDA use.  Much of what we are discussing here is off-label FDA use.  For some of my Hylenex cases, I dilute the Hylenex with Saline.  My formula varies with the application, and thus I have been able to thin out the problem to an appropriate degree and thus have a happy outcome without having to reinject filler or to have a complete loss of filler in a particular area.  This is a tricky process, and I sometimes manage this in a staged approach – meaning multiple sessions.

​Calvin Lee, MD
​Modesto, California Belotero Injector

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