What is Hyaluronidase?

Have you recently had cosmetic injections of dermal fillers such as Juvederm or Restylane and are unhappy with the result? Maybe you’re happy with one side of your face, but not the other? If you’ve locked yourself away in your bedroom thinking that you’ll just have to live with your “bad filler”, think again!

Hyaluronidase is an enzyme that can be injected to dissolve fillers like Restylane, Juvederm, Lyft, Belotero, and more. It is quick, easy, and relatively painless. Best of all, hyaluronidase begins working almost immediately to dissolve the bonds between the molecules of hyaluronic acid that make up popular filler products like Restylane, Juvederm, Restylane Lyft, and Belotero.  Because it only works on hyaluronic acid, hyaluronidase cannot dissolve other types of fillers like Radiesse, Sculptra, and Artefill/Bellafill.

You may need more than one injection session to completely dissolve your unwanted filler, but many people get good results after their first round of injections and many see full results within just 1 to 2 days!

Hyaluronidase goes by many different trade names: Vitrase, Wydase, Amphadase, and Hylenex are the most common. Here at Celibre Medical, we use Vitrase and find that it gives very good results for our patients. To see an example of the excellent results we’ve achieved with Vitrase, take a look at the photos on this page.

Don’t live with dermal filler that you don’t like or aren’t 100% happy with. Let us help you today get the results that you really want and will love!

You finally did it! You went and got Restylane or Juvederm injections for tiredness under your eyes that has been driving you crazy.  But after a few days, you notice something that doesn’t look quite right.  A bluish or greyish discoloration is visible at the point of injection.  Are you seeing things? Is this normal, and if it isn’t, how can you make it go away?

Getting dermal filler injections is a big decision. It takes time and research to understand what the procedure can and can’t do for you. You must find an injector who shares your vision that also has the skills and knowledge to make it a reality. Unfortunately, this can be the hardest part.  Not every injector has the same skills. And while some have the knowledge of the proper placement and techniques that are needed to perform filler injections, their technical skill may not always be up to that same level.

If you’ve noticed a bluish or greyish hue where you’ve had filler, you may be visualizing a  phenomenon known as the Tyndall effect. Without getting too heavy into the physics of light, what’s happening is that light is “reflecting” off your hyaluronic acid-based filler such as Juvederm or Restylane because it’s placed too close to the surface of your skin. Although your injector may have used the right product for your procedure and got the location of your injections right, he or she just didn’t put the filler at the right depth. You can see an example of what the Tyndall effect looks like in the photo here on this page.

The Tyndall effect is just one of the reasons that who you see for your injections is just as important as what you have injected. Your injector needs to understand the proper depth of placement for your dermal filler product to avoid the Tyndall effect.

Once it’s there, the only way to get rid of the Tyndall effect is to get rid of the filler itself.  The best way to reverse the filler is to dissolve the filler product with Hyaluronidase (Vitrase).   Hyaluronidase is an enzyme that breaks down common fillers like Restylane and Juvederm immediately.  The painful part is that you then must start over again at square one with your filler.

Over the last several decades, hydroquinone, (HQ) has become the gold standard treatment for many skin conditions that require lightening. As the use of hydroquinone has grown, there has been much debate as to whether it’s safe and effective.

melasma before and after pictureOne study commonly cited as evidence for the link between hydroquinone and cancer was based upon oral ingestion of hydroquinone in lab rats and mice. Although there is value in extrapolating information from research such as this, it was recognized that the studies were lacking and are now considered outdated.

Further, there are also reports of hydroquinone use and darkening of the skin – a condition referred to as ochronosis. Although possibly underreported, ochronosis cases are very rare and associated with sun exposure, and prolonged use at high concentrations. The FDA has called for more current and inclusive studies that focus on the dermal application (on the skin vs oral) of hydroquinone to determine its effect on humans.  The FDA’s position is that hydroquinone is generally safe and effective.

Currently, HQ is available without a prescription in numerous over-the-counter products at a 2% concentration. Typically, 4% is what most physicians prescribe and is also found in Obagi and other name-brand products. Anything above 2% is considered a prescriptive product and requires a prior exam by the physician, Nurse Practitioner, or Physician Assistant. This fact is important because consumers routinely purchase these products online or even at Medical Spas without going through the required prescription exam. Those practices dispensing or selling anything above 2% HQ without the required medical exam are breaking the law.

The potential adverse side effects of HQ are directly related to improper use of the product. Rather than the percentage of HQ, the more concerning factor is prolonged and uninterrupted usage of the product. For example, consumers often purchase numerous HQ products for use simultaneously. Without proper supervision and instruction, consumers expose themselves to risk by using low percentages of HQ for an extended period of time. Continuous use is where the risk lies.

At Celibre, our position is clear: hydroquinone is safe and effective when used appropriately.

Appropriate use of Hydroquinone:

  • Prescribed by physician or physician extender for the purpose of addressing brown pigmentation on intact skin.
  • Proper screening to eliminate questionable candidates (liver disease)
  • Education – the patient was discouraged from using multiple products of HQ and adhering to safe protocols
  • 4% and 8% concentration.
  • Limited Sun Exposure.
  • Limited consecutive usage, not beyond 90 days without a 30-day break.
  • Non-HQ program to sustain benefits when on break from hydroquinone.

Because hyperpigmentation (ex: brown discoloration) can be distressing for our patients, the topical HQ program is an excellent option.

It’s not unusual for patients, both men, to voice concern about their motivation for seeking out aesthetic treatments.

Some curious men will ask, “Do many men get these treatments?” Women, on the other hand, will say, “No one knows that I do these treatments. I’m treating myself today.” A more recent question that I’m asked by patients when receiving their injection treatments is, “do you think I’m being vain?

being vain with botoxI always pause before answering that sincere question. I recognize that the average patient works hard to invest in botox treatments, and I’m very aware that they are trusting me with this investment in themselves.
My answer remains the same. “No, I do not. Wanting to help your frown lines or freshen up your appearance is no different than getting your hair done or working out to maintain physical health.”

If we give attention to our physical health, maintaining our hair, nails, or wardrobe, then wanting to improve an important asset, our face, fits nicely into that routine.

I recognize that in this day of endless selfies, outrageous aesthetic treatments, and a society that is overwhelmingly promoting self-centeredness, it’s no wonder that a patient would pose that question.

I have often repeated a mantra over the years of, “crazy people do not wonder if they are crazy.” We can translate that to, “narcissists do not wonder if they are narcissistic” and finally….Vain people do not wonder if they are being vain.

You’re browsing Realself and you keep coming across the term “brow shaping”. If you’re thinking this term relates to plucking, tweezing, or waxing the eyebrows, think again! In the aesthetic world, brow shaping refers to techniques and treatments that change the position, lift/arch, and or volume of the eyebrow and the area around it.

Why is this important? Because no other area reveals more information about your age than your eyes. Signs of sun damage, volume loss, and skin laxity show up here first before anywhere else on your face. A skilled aesthetic practitioner knows this and understands the value of using minimally invasive treatments such as Botox Cosmetic and dermal filler injections to correct and reverse these changes.

If you feel like your brows are flat, there’s an easy way to both lift and arch them with Botox. When precisely and carefully placed into the right facial muscles, Botox can completely change the shape and position of your eyebrows. Lifting them, opening up your eyes, and smoothing out the skin around the eyes can take years off your appearance.

If your brow bone (or bony eye socket) has flattened, then injections with dermal filler products such as Juvederm and Restylane can softly and naturally reshape your brow. This in turn also lifts and shapes the eyebrow.  Are your eyes looking hollow?  Temples sunken in? Do these changes make your eyes look sharp or angular?  If so, hyaluronic fillers such as Restylane can safely be used under your eyes and in your temples to add volume, and “round out” your upper face.

Restoring the balance and natural contour of your eyes can help you look refreshed, younger and relaxed. Remember, your eyes are the focal point of your face—your most important facial feature!

Read About All Celibre’s Facial Shaping Techniques

View All Blogs

While it may have a funny, unique-sounding name, melasma is an all-too-common problem. Maybe you or someone you know has it, but you didn’t know it had a name? It causes dark, brown patches most commonly found at the upper cheek, upper lip and forehead. These brown spots come on quickly (during pregnancy, starting birth control, over the summer or after a vacation) can be large and are often symmetrical. Worse, they are almost impossible to cover up with make-up!

Many women are confused about what causes melasma. In truth, we aren’t 100% sure either! But, we know that there are a variety of triggers and that hormonal changes play a major role. Pregnancy (pregnancy mask/chloasma), the use of birth control pills and menopause are common in the onset of the condition.  Many patients believe that sun exposure, heat and humidity cause Melasma, but in reality they can make it worse, but not cause it.

* Melasma before and after photos

Because the exact cause remains unknown, Melasma can be treated but in many cases remains chronic.  Often, people who have it struggle over their lifetime with it.  Even so, your condition is not hopeless and we can effectively manage this difficult condition!

We understand the frustration and difficulty you’re going through when you have melasma. Chances are you’ve tried many different things to look and feel better, but many aren’t successful. We are here to help you! We can help you understand your condition better, provide an excellent treatment option and explain how to modify your lifestyle to avoid Melasma triggers.

With a good treatment partner, you can have clearer skin and win over melasma! Celibre Medical has helped many women (and a few men) gain control over it and keep it in check. We are confident that we can do the same for you.

View All Blogs

It is not uncommon for men and women to confuse sun damage with melasma as both conditions involve pigmentation on the face. Despite the similarities in pigmentation, melasma and sun damage are actually quite different. The source of the discoloration is the major difference between the two melasma and sun damage. For example, melasma is caused by pigmentation (melanocytes) that is generated in response to hormonal fluctuations. Because it is related to hormonal changes (pregnancy, menopause, oral contraceptives, etc.) it is considered chronic and has no cure. The idea behind melasma treatment is to control and suppress the formation of new pigmented cells thereby minimizing the appearance of melasma. One of the challenges in treating melasma is that is can occur in the dermis (deep skin layer). Because the condition can be rooted deep in the skin, the condition can be sometimes be resistant to treatment.

Sun spots


sun spots and melasma before and after photos los angeles sun spots and melasma before and after photos los angeles
Sun spots and Sun damage laser treatments before and after pictures

In contrast, the pigment associated with sun damage (solar lentigines, seborrheic keratosis, freckles, sun spots, liver spots) lies closer to the surface of the skin and is much less challenging to treat. Existing sun damage is effectively treated with class IV medical lasers whereas melasma may be better addressed with topical preparations. Q-switched (very short pulsed and high powered) laser technology is very effective at breaking down the pigment associated with sun damage in several treatments. This technology also has the benefit of completely destroying the cells associated with the pigment. This means that new cells replace the old ones and do not contain the same pigment that was present previously. With q-switched laser technology, we are able to completely remove most age spots and sun damage.

The following descriptions highlight the differences between melasma and sun damage.


Light to dark brown patches usually seen on the forehead, cheeks, chin, upper lip.

Very symmetrical in appearance on both sides of the face.

Discoloration may be dense pigment and may lie on the epidermis (upper layer of skin), dermis (lower layer of skin), or combination of both.

Linked to hormonal changes and considered a chronic, recurring condition.

Sun exposure, heat and humidity may exacerbate condition.

Sun Damage (Sun Spots, Age Spots, Freckles, etc.):

Appears randomly on all areas of the face.

Usually not symmetrical, may be patchy or scattered.

May be associated with textural changes to the skin also known as photo-damaged skin (lines, wrinkles, etc.)

Not related to hormonal changes but directly linked to sun exposure.

Responds well to lasers.

Not considered a chronic condition.

View All Blogs

View All Blogs

We know that having melasma can be frustrating, embarrassing and hard to deal with day after day. It’s an extremely common condition yet despite that, we still don’t yet have an effective cure for it. But don’t give up! There are treatments that can control melasma and make it much more manageable! Finding a good practitioner who is experienced and educated about melasma treatment can make all the difference in helping you beat this difficult skin problem.

melasma treatment los angeles before and after photoslos angeles melasma treatment before and after photosMelasma is a problem with excess pigment. The cells in your skin that make pigment are called melanocytes. In melasma, the melanocytes are overly stimulated to make pigment and this results in the dark patches that pop up on the forehead, cheeks and upper lip. Hormonal stimulation is the culprit that triggers the melanocytes to work overtime. This is what makes melasma so different from and much harder to treat than other conditions that include brown spots like freckles, sun spots, brown acne scars and moles.

Treatment for melasma is designed to fade the brown patches and then maintain your clear skin; so, it’s very important to realize that it is an ongoing process. Once you’re better, you need to continue with prescription medication or you will end right back up at square one. The cornerstone of melasma treatment is usually hydroquinone, a bleaching medication that works to suppress excess pigmentation. There is no one mix that works for everyone, so it’s important to be patient, use your product as directed and follow up with your practitioner frequently to assess your response to treatment.

The bottom line to remember with treatment of melasma is that there is hope—and many options for treatment. With patience and diligence, you can and will get better. Hang in there!

Here at Celibre Medical, we offer two, different treatment plans for melasma. We encourage our patients to ask questions and we work hard to make sure that our patients understand their condition. There’s no way to predict which of these two will work for each person, so we let you know this up front and we never make you promises that we can’t keep. We know that successful treatment of melasma depends on an ongoing relationship with you and we’re your partner for the long haul!

Melasma before and after photos

View All Blogs

View All Blogs

You’ve read about threading for hair removal and have talked to your friends who absolutely love it. You’ve decided to try it and you’ve booked your first appointment. But before you head over to the salon, we’d like to caution you about a few things that may make you think twice about using threading as your go-to method to get rid of hair.

Many people don’t realize that there can be potential unwanted side effects with threading such as acne-like breakouts, infections and darkening of the skin. While threading has been around since ancient times, it may just not the best modern-day solution for you to get rid of your unwanted hair!

picture of side effects of threading

Threading is a technique in which unwanted hair (usually facial hair) is epilated (pulled out) by an intricate rolling and twisting of fine threads over the affected area. No doubt, threading leaves your skin completely smooth, but it also is extremely irritating! Often touted as “exfoliation”, the threads can damage the very top layer of skin, the epidermis, as they pull out the hair. This basically creates thousands of tiny pathways for infection-causing organisms to gain entry to your skin. Don’t think it can happen? A recent study reported multiple cases where patients developed warts after threading due to infection from HPV (human papilloma virus) transmitted this way.

Many practitioners who provide threading use their mouths to steady the threads during the procedure. That’s because they still practice threading today like practitioners in ancient times. And while that may have seemed like a good idea back then, we know now that the human mouth is dirtier than the average toilet seat!

If you are prone to acne (or even if you aren’t), the traumatic nature of threading can leave your hair follicles irritated, stimulating a breakout that looks like tiny, puss-filled pimples. Known as folliculitis, you can see an example in the picture of the woman on this page. The last thing you want to do is to trade your unwanted hair for a bigger problem—unwanted breakouts.

If you take a second look at this picture, you’ll also see an example of the unintended problem of hyperpigmentation or skin darkening that can occur after threading. This doesn’t happen to everyone after, but if you have darker skin, your pigment cells may respond to the irritation threading triggers by making more pigment, leaving you with unwanted dark patches on your skin. Again, it’s a safe bet to say this young lady would have kept her hair or chose another hair removal method if she knew this is how she’d look after threading!

By now, you’re probably wondering if you should just skip your threading appointment. Here at Celibre, we won’t tell you what you should do, but we do want you to be informed of the potential risks and unwanted side effects that are possible with any type of popular treatment. Sometimes, a procedure gets a lot of hype and the truth gets lost in the all noise. A procedure such as threading for unwanted hair removal may not be the “panacea” that the media and your friends make it out to be!

Our practice doesn’t offer threading. We offer class IV medical laser treatment for unwanted hair. We do realize there are potential risks with laser hair removal as well, and we will always make it our priority to discuss these with you prior to starting treatment. Each device that we use is FDA-approved for laser hair removal and we have multiple, different devices that have been consistently shown to be both safe and effective to permanently remove your unwanted hair, no matter what your skin type (color).

Unlike threading, which hasn’t evolved much, Celibre offers only the latest and most up-to-date laser treatment. Our practitioners stay at the forefront of this growing field by maintaining the highest levels of continuing education and hands-on experience.

View All Blogs

At Celibre Medical, we approach acne from a different perspective. We truly understand how your acne can impact your entire life…not just your skin. We are committed to providing you with the safest, most innovative, and personally tailored acne treatment plans.

Part of this relationship involves straightforward advice and recommendations for ways to manage your acne. Our practitioners have spent years learning and observing what works for the treatment of acne and what doesn’t. Many acne patients come to us extremely confused about what products are “good for” or “safe” to use on their skin. One of the most frequent of these products is mineral makeup.

Infomercials and other forms of direct-to-consumer marketing would have you believe that mineral makeup is an answer (almost a treatment) for acne and acne-prone skin. We believe the opposite. There are many terms that get thrown out there in these marketing ploys: oil-free, safe for sensitive skin, mineral-based, natural, etc. While all these tend to lead you to believe that they are good for acne, they actually aren’t. For a product not to be acne-stimulating, it needs to be labeled non-comedogenic.

Non-comedogenic means that a product doesn’t block or clog pores – which is the first step in the formation of acne. While the mineral makeup manufacturers typically don’t use this term, they use almost everything else to lead you to believe that their products are good for acne. It’s no surprise that most of our acne patients are hesitant to give up mineral makeup. They’ve been falsely led to believe that it’s helping when more than likely, it’s only been adding to their acne problem.

We understand this may be an unpopular opinion. We also can’t prove our position with any formal research or outside verification. This is simply our professional opinion based on years of clinical observation.

  • Mineral makeup is extremely difficult to remove (fully) from the skin. We have had negative skin reactions occur during laser treatments due to mineral makeup. This leads us to believe that there is a “residue” of mineral-containing particles lodged within the pores even after several washings.
  • Celibre Medical has repeatedly contacted the manufacturers of several prominent mineral makeups asking for research or documentation supporting their claim of being “safe” for acne patients. We continue to receive no response.
  • Every acne patient who we have persuaded to discontinue the use of mineral makeups has seen improvements in their skin–every single one!

We are not against these companies or products at all. But we are against what we believe to be false advertising claims of being “safe” or “helpful” for acne-prone skin. Our years of real-world experience and clinical observations tell us this just isn’t true! We don’t promote one product over another, but we do want our patients to get better. And this means we discuss the use of appropriate skin care products that help us reach this goal, not sabotage it.

orange county california acne laser treatment before and after picturesorange county california acne laser treatment before and after pictures

View All Blogs

Contact us for a FREE Consultation