My cheeks look too plump post-Botox and Perlane!

If you are unhappy with the result, it can be treated with hyaluronidase. Or, you can allow the product to degrade on its own, but it will take 6-9 months.

Baby Face:

Perlane is a soft tissue filler comprised of hyaluronic acid which is a chemical found naturally occuring in human skin. Perlane is a "stiffer" product of larger particle size purposefully designed to be injected into the deeper layers of the skin. Typically, Perlane lasts about six to nine months. Perlane can be reversed by injecting hyauronidase into the treated areas.

Please see your treating physician and discuss your concerns with him/her. Study your before and after photographs- including animated views- before making any decisions.  Keep in mind that looking straight ahead in a mirror may distort or magnify your image.  Lastly, I would wait at least three weeks to allow the treated areas to settle down and the swelling and brusing to subside. If your are still upset, then I would speak to your doctor about having the Perlane treated areas reversed. 

Thank you for your question!

-Stephen Goldstein, MD, FACS

Hello Babyface,

Very good advice given to you on this post.

I would like to add two additional comments that may be of assistance to you.

First of all,  the swelling you are experiencing is not due to the Botox.  In my experience Botox can be used very effectively in the cheek area to help "soften" the nasolabial folds.  By doing this the filler can be more effective since the wrinkle is not as deep as it was before the Botox.

Secondly, depending on how long it has been since the Perlane was injected, you could ask your Physician to do a "needle extraction" of the excess Perlane.  This is a highly effective way to remove the Perlane and works quicker than hyulronidase injections.

Take Care, Dr. Jafri

The advantage of temporary fillers is just that, they are not permanent.  They will go away and your contour will return to the pre treatment appearance.   You can speed up the process with hyaluronidase injections into the areas of the Perlane.  This type of injection will dissolve the filler product and return it to the natural state.  It may take more than one treatment.  We are very conservative with our injections.  Not unlike the comment from another doctor, more is not always better. 

You will find in the future that a little less is better for fillers and botox

Time will take care of this, but it will probably take several months.  The skin injected with Perlane is getting  " bunched up " when you smile and so it creates too much fullness.

Perlane can be dissolved with injections of hyaluronadase, but these injections can also cause irregularities in a large area.  So, hard as it is, I would just wait, knowing that you will look better in a few months.

Baby Face,

Sometimes in an effort to achieve perfection we turn a good result into something less desirable.  This is the best argument for experience in the cosmetic field -- knowing when to stop. 

One of the negative attributes of Perlane is that it is a temporary filler and lasts on the order of 6-9 months.  In your situation this a positive attribute, since your results are dissatisfying. 

Also, the degradation of the product is gradual so that by 6-9 months the product is completely dissolved.  This means that your cheek fullness will improve in less than 6-9 months and you may be ecstatic with the appearance by 6-8 weeks. 

For this reason, I would consider holding off on injecting Hyaluronidase to dissolve the Perlane, as every intervention brings with it a certain amount of uncertainty and risk, and reassess after this time. 

Good luck!

Botox is unlikely to have caused the fullness in the cheek area even if it were injected close to or within the cheeks.

If indeed the fullness is due to Parlane, it is not an unusal finding within the first few weeks of the implant. If you feel a lot more than you can see this effect, I'd not do anything about it. The fullness resolve pretty soon. Just about all fillers will create bumps (nodules) when first injected. Again you should be able to feel but not see them that much. These resolve much sooner (weeks) than the total effect of the filler. You should probably have someone else take a look and see if they appreciate an obvious defect.

As noted by Dr. Colen, one of the advantages of hyaluronic acid based fillers over the rest is that hyaluronidase can dissolve the filler. Discuss the feasibility of this with your physician if indeed that is the approach you choose to take. If you do nothing at all the effect of parlane will be gone by the 12th month after injection. Another advantage of temporary fillers.