Overcorrection with hyaluronic acid

Definition: What is hyaluronic acid overfilling?

One Overcorrection with hyaluronic acid (also known as overfilling or over-augmentation) occurs when too much hyaluronic acid filler has been injected into a specific area of the face during wrinkle treatment or volume enhancement. The tissue is unable to cope with the volume, leading to unnatural, sometimes mask-like proportions, visible bulges, lumps or a feeling of tightness. Overfilling can also cause the material to shift into neighbouring areas (known as ‘filler migration’).

The Time Check: Just bloated, or is it really too much?

Many patients start to panic just a few hours after treatment. But be careful: hyaluronic acid has a strong ability to bind water. Furthermore, the tissue reacts to the injections by becoming inflamed and swollen.

Before you assume that there has been overcorrection, you should bear this timetable in mind:

1. Days 1 to 7 The treated area is almost always excessively swollen, often asymmetrically so, and feels firm. This is a normal post-operative reaction and is not yet a cause for concern.
2. Weeks 2 to 3 The tissue heals, the hyaluronic acid integrates into it and binds water. The swelling subsides significantly. The result looks more natural.
3. From week 4 It is only now that the final result is visible and can be assessed. If the lips or cheeks still appear unnaturally large, plump or lumpy, it is highly likely that genuine overcorrection has occurred.

The 3 solutions for hyaluronic acid overcorrection

If, after four weeks, it is confirmed that too much material has been injected, you have a number of options:

1. Wait and see (the passive approach) Hyaluronic acid is a substance that is broken down naturally by the body’s own metabolic processes. In cases of minor overcorrection, simply waiting is often the gentlest option. Depending on the degree of cross-linking (viscosity) of the gel used and the area of the body supplied with blood, this natural breakdown process takes between 6 and 18 months.
2. Massages and heat (as directed by a doctor) In the early stages, whilst the hyaluronic acid has not yet fully integrated into the tissue, a doctor may use or recommend specific, targeted massage techniques to smooth out minor irregularities. Mild heat (e.g. infrared light, warm compresses) can also slightly accelerate blood circulation and, consequently, the natural breakdown process. Warning: Never massage the area yourself, as you may inadvertently push the filler into other areas!
3. Dissolution by hylase (the active solution) If the level of discomfort is high, large lumps (granulomas) have formed, or the material is pressing on blood vessels or nerves, dissolving the filler with medication is the most effective option.

The gold standard: lysis with Hylase

The most effective weapon against excess hyaluronic acid is the enzyme hyaluronidase (or ‘Hylase’ for short).

• How it works: Hylase is injected directly into the affected, over-injected areas (e.g. the unsightly bulge on the lip) using fine needles. The enzyme breaks down the structure of the hyaluronic acid gel, turning it into a liquid and thus enabling the body to rapidly eliminate it via the lymphatic system.
• Result: The effects often become apparent within a few minutes to a few hours. In many cases, the excess volume is significantly reduced within 24 to 48 hours.

Causes: How overcorrection occurs

Overfilling rarely results from malicious intent, but is usually due to a misjudgement:

• Lack of experience on the part of the practitioner: Incorrect choice of injection depth, incorrect product selection (gel that is too firm for, say, thin lips) or simply an excessive amount injected.
• „Blindness“ (Filler Fatigue): Once patients or doctors have become accustomed to voluminous results, they often lose their objective perspective on natural proportions and demand/inject more and more.
• Failure to wait and see: If a follow-up injection is administered too early, before the tissue has had time to incorporate the first dose and for the swelling to subside.

Financial security in the event of complications

Overcorrection with hyaluronic acid is not only frustrating, but also leads to unforeseen costs. In most cases, you will have to bear the costs of the corrective treatment with Hylase (often involving several sessions) and any subsequent, professionally performed reconstruction yourself. In the case of cosmetic procedures that are not medically indicated, your statutory health insurance may require you to contribute towards the costs of treating complications, in accordance with Section 52(2) of the German Social Code, Book V (SGB V).

To protect yourself against these substantial and frustrating follow-on costs, you should take out a Consequential Costs Insurance an essential component of your financial security when it comes to cosmetic treatments.

Frequently Asked Questions (FAQ)