Ben Talei, MD
DIRECTOR
Board Certified.
Dual Fellowship Trained.
Facial Plastic Surgeon.

Revision, Repair & Reversal of Botox and Fillers

With the increasing popularity of cosmetic treatments, our practice has experienced a growing volume of patients. These patients are seeking treatment to correct treatments that are not always customized or suitable for each person. At the Beverly Hills Center for Plastic & Laser Surgery, Dr. Talei has dedicated his practice solely to the face. In doing so, he has a substantially heightened his ability to treat primary and revision patients with nuances developed after helping innumerous patients with novel and customized treatment plans. He is able to obtain more natural and more impressive results using his careful and thoughtful techniques, following a thorough analysis of your facial characteristics and needs.

Can Botox, Xeomin, or Dysport Be Reversed or Removed?

Various forms of botulinum such as Botox, Xeomin, and Dysport, are time-tested and very safe for patient administration. These medications are specifically designed to produce a clinical effect of muscle weakening (paralysis or paresis). This is by binding to receptors in the presynaptic nerve terminal and preventing the communication of a signal from one nerve to the next and to the end point, which is the muscle.

Because of this mechanism of action, once the medication has bound at its end point, it cannot be removed. Return of muscle function does happen, and this typically occurs progressively over the next two weeks to nine months. The greatest effect of the medication is seen as it begins its action between 3 and 10 days following injection. Some patients, especially older patients, may experience an exaggerated effect during this time until clinical plateau and resolution begins. Hence, evaluation and retreatment of the injection outcome generally should not be considered until that time. This is unless there is a gross and disfiguring asymmetry, which is very rare.

Can Botox, Xeomin, or Dysport Be Fixed or Repaired?

Although there is no form of injectable botulinum in existence that can be reversed, many of the adverse effects of these medications can very easily be managed in most instances. In order to do this, you must consult with an experienced specialist with a profound understanding of muscular anatomy and the facial dynamic. The muscles in the face are in a continuous harmony and equilibrium with each other as they gently pull away from one another. Muscles only have the ability to contract, flex or pull, and they cannot push or lengthen actively.

The effect of botulinum is to weaken the pull of the muscle. Since this cannot be reversed specifically, the majority of Botox repair or revision focuses on the weakening of another set of muscles, which are pulling in an opposing direction. Alternatively, the physician may elect to weaken the contralateral side alone or in conjunction with treating the problematic side. This is in order to gain a more appealing outcome and improvement of asymmetry.

Many of the following difficult and disfiguring issues may be treated by a specialist using precise administration with the correct dilution or concentration in most cases:

  • Asymmetric or strange smile
  • Brow drooping and brow ptosis
  • Heavy, small or narrow appearing eyes
  • Wavy lines or asymmetry in the forehead
  • Surprised look
  • Spock look
  • Clown eyes and clown brows
  • Facial asymmetry
  • Rainbow lines or persistent arched lines over the lateral eyebrows
  • Awkward or strange appearing eyebrows

Can Facial Fillers be Dissolved, Reversed, or Removed?

The most popular types of fillers in the United States include hyaluronic acids (HLA), calcium hydroxyapatite products (Radiesse), poly-l-lactic acid, polymethylmethacrylate and silicone. Collagen injections are rarely used in current times. Of these, the HLA products can be dissolved using hyaluronidase (Vitrase), which is a bovine related product with a low rate of adverse effects. The other fillers mentioned cannot.

Worldwide there are dozens of reliable HLA products available. In the United States, the most popular are Juvederm, Voluma, Restylane, Perlane and Belotero. These HLA products can all be dissolved to various degrees at any time using small amounts of hyaluronidase. The effect of the enzyme begins almost immediately, but it takes several days to reach full effect. Once dissolved, a second treatment may be performed very conservatively to remove the remaining pockets of filler. A repeat treatment of fillers can also be performed in a more appropriate manner.

Very rarely, there may arise suspicion that these products are infected. The infections are treated just like any other skin infection with the use of antibiotics and occasionally steroids, depending on the clinical scenario. Caution must be taken dissolving HLA fillers during an acute and active infection as this may perpetuate the infection in certain instances when injected too early. In scenarios such as these, the patient must be sure to seek treatment from a specialist.

Can I Fix, Remove, or Revise Silicone?

Silicone can be used for facial augmentation in the form of an injectable filler or an implant. Silicone implants are simple to manage and do wonderfully for most patients. Silicone when used as an injection can be a bit tricky, however. Over the years, silicone has been injected in all areas of the face. More recently, most patients receive injections for lip augmentation.

The benefit of silicone is that it is a permanent filler and does not need to be placed repeatedly as HLA fillers do. This also happens to be the downside of silicone, however. When adverse outcomes arise, they are a bit more difficult to resolve. The reactions may occur immediately or several years later. They may be as subtle as irregular or granular, appearing skin on the lips. The only non-invasive therapies that have demonstrated some improvement are ultrasound or radiofrequency treatments such as Ulthera. These treatments occasionally can shrink the surrounding tissues when reactions occur. Otherwise, small procedures are the most effective in improving the appearance.

Common Issues Related to Over-Filling and Improper Placement

There are several commonly encountered issues related to repeat filling, over-filling or improper placement of filler. Treatment of these situations can be a bit complex, depending on the type of filler, location and duration the filler has been in place. Several theories exist as to why each type of complication happens which help avoid the occurrence of these problems. The following are commonly encountered complaints treated in our practice:

  • Baggy, swollen or tired appearing under-eyes
  • Incorrect filler under the eye which may last years
  • Blue or watery hue under the eyes
  • Simian (monkey) appearance, making the mouth appear too prominent and round
  • Low, fatty cheeks
  • Lengthened or fatty upper lip
  • Loss of lip curvature and definition
  • Lack of facial definition and facial subunits
  • Masculine or over-volumized face
  • Lumps and bumps
  • Asymmetric appearance

At the Beverly Hills Center for Plastic & Laser Surgery, we are specialists dedicated to the face. Our profound understanding of the facial dynamic and commonly encountered issues with both invasive and non-invasive treatments, has helped us as a leading figure and referral center for complications related to injectable treatments. In addition, our understanding of the face enables us to achieve results rarely seen elsewhere. Contact us today to schedule a consultation for you or a family member.

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5.0

Based on 15 reviews

Peter S.
Literally one of the best facial plastic surgeons in the world. You will NOT regret being treated by this highly skilled professional. He's a mensch, too.
darci t.
I am absolutely ecstatic about my results!!!!!! I am a model and actress as well as an occasional TV host. I have been performing upkeep for my face and lips in Beverly Hills for years and I was convinced I was with the most talented and famous surgeons and dermatologists, but boy was I wrong! One visit with Dr. Talei and my life has changed. He clearly and quickly explained the slow imbalance which had happened in my lips and face over time and we planned for a lip lift procedure. I did this under local anesthesia with no pain at all! He's the ONLY surgeon who can do this with NO scarring. All other doctors I reviewed had scars on at least half their patients. Now all of my friends in plastic surgery and fashion compliment me much more and they have no idea what I had done. This man is AMAZING!!!!
Jennette C.
I went to Dr Talei for under eye filler using Restylane. Dr Talei was very thorough with each step in the process and made me feel very comfortable. The procedure was quick and painless! My under eyes have always been an insecurity for me and when I looked in the mirror after he was done I was beyond impressed with his work. I felt more confident and beautiful. I was able to leave his office and go right back to work! I highly recommend Dr Talei. He's friendly, has a lovely staff and truly cares about making his patients happy.
Lauren F.
My experience with Dr. Ben Talei was very positive. He answered all my questions prior to the procedure and made me feel very comfortable. Before meeting him, I had heard all the rave about his work, and I am so glad I went through with the visit. I was very insecure with my "eleven" deep wrinkles in between my eyebrows, he was very fast and clean with this procedure and I couldn't be more grateful for this minor adjustment that has brought me a major confidence boost. Thank you Dr. Talei
Bryan B.
Ben is a skilled professional. I would have no hesitation recommending Ben and his team to my friends or family. He is passionate about his work and this passion shows in the exceptionally high standard of care that he provides to his patients (both in his practice and in his humanitarian work). You’re in good hands with Ben and his staff!
Danielle B.
I used to see Dr Ben in New York and now I fly to LA to see him. I have no room for error and he is absolutely the only plastic surgeon I trust. Everyone else seems to be out for money. Every time I'm in his waiting room all I hear is praises and how he's the greatest. I completely agree. He's the most talented surgeon I've ever seen. It's worth the flight
Kelly H.
I have worked in health care in Los Angeles for over 20 years and have always hesitated in referring plastic surgeons to my clients. Dr. Ben Talei, MD is in a class of his own. I am so pleased to be able to refer to Dr. Talei without hesitation, and consistently receive outstanding feedback on him. Dr. Talei brings a wealth of experience and exceptional skill, along with cutting edge techniques to his practice. Not only does Dr. Talei excel in every facet of care, but he has also cultivated a warm, kind and patient bedside manner that is second to none. Dr. Talei's office is a dynamic patient focused environment, I urge you to visit him!
Holly K.
Ben is amazing! Was my first time getting botox and it was virtually painless. Marks were gone in minutes. Thanks Ben you're the best!!!