Dissolving dermal fillers

One of the practical advantages of hyaluronic acid dermal fillers is that they can be dissolved. An enzyme called hyaluronidase breaks down hyaluronic acid, and injecting it into a treated area removes the filler.

This matters for two quite different reasons: it gives people a way out of a result they are unhappy with, and it is the emergency treatment for the most serious complication of filler injection.

How it works

Hyaluronidase is an enzyme that breaks the chemical bonds holding hyaluronic acid gel together. Injected into or around the filler, it breaks the product down into fragments the body clears naturally.

The effect begins quickly - often visible within 24 to 48 hours - and continues to settle over the following days to a couple of weeks. More than one session is sometimes needed, particularly with firmer, more cross-linked products or where a large volume was placed.

Hyaluronidase is a prescription medicine. It must be prescribed by a doctor after a consultation, and Australian law restricts what can be published about prescription medicines.

What can and cannot be dissolved

Hyaluronic acid fillers can be dissolved. These are the most commonly used fillers in Australia today.
Non-hyaluronic acid fillers cannot. Calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate and silicone are not affected by hyaluronidase. Removing those, where it is possible at all, may require surgery.
Permanent fillers are the hardest problem. This is the single strongest practical argument for using a reversible product in the first place.

If you do not know what was injected, say so at consultation - the record from the original treatment matters, and where it is unavailable, imaging such as ultrasound can sometimes help identify what is present.

Why people have filler dissolved

An unsatisfactory result - too much volume, an unnatural shape, or a change they no longer want.
Asymmetry that has not settled.
Lumps or nodules, including ones that appear months after treatment.
Migration - product that has moved from where it was placed. This is most commonly seen around the lips, where it can produce a shelf above the lip border.
Tyndall effect - bluish discolouration where filler sits too superficially, most often under the eyes.
Delayed inflammatory reactions, sometimes triggered by illness or vaccination.
Accumulated filler over many years, where repeated treatment has changed the shape of the face more than intended. Dissolving and starting again is a legitimate approach.
Before surgery, where filler would complicate a planned procedure.

The emergency use: vascular occlusion

The most serious complication of dermal filler is vascular occlusion - filler entering or compressing a blood vessel and blocking blood supply. Untreated, this can cause tissue death and, where vessels supplying the eye are involved, permanent vision loss.

Hyaluronidase is the treatment, and it is time-critical - the sooner it is given, the better the outcome. This is why any practitioner injecting hyaluronic acid filler should have hyaluronidase immediately available in the room, and why it is a fair question to ask before treatment.

Seek urgent medical attention if after filler treatment you experience severe or increasing pain, blanching or mottled discolouration of the skin, or any change in vision.

What to expect

The treatment itself is quick. Expect some redness, swelling and possible bruising at the injection sites, generally settling within a few days. Swelling can be pronounced initially and can make it hard to judge the result for several days.

Once swelling settles, the treated area returns toward its pre-filler state. It is worth being clear-eyed about this: dissolving filler in a face that has aged since the filler was placed reveals the face as it is now, not as it was then. Some people find that confronting, and it is better to expect it.

Where a further filler treatment is planned, practitioners usually wait a period after dissolving before re-treating, so the area has settled and residual hyaluronidase is no longer active.

Risks

Pain, redness, swelling, bruising and tenderness at injection sites
Allergic reaction, including rarely anaphylaxis - hyaluronidase is derived from animal or recombinant sources and allergy is a recognised risk. A skin test is sometimes used beforehand
Infection
Dissolving more than intended, including some of the body's own hyaluronic acid in the surrounding tissue, which can leave the area looking temporarily hollow or lax before it recovers
Incomplete dissolving, requiring further sessions
An unsatisfactory appearance after dissolving
No effect, where the product injected was not hyaluronic acid

Please read our information on the risks and complications of cosmetic surgery before proceeding.

Cost and consultation

Cost depends on the amount of product to be dissolved, the areas involved and whether more than one session is needed, and is quoted at consultation. As at September 2024 and including GST, a consultation with a Cosmetic Doctor is $150.

Bring whatever records you have of the original treatment - product, volume, areas, date and who performed it. It genuinely changes the assessment.

Me Clinic is at 4 Burke Road, Malvern East VIC 3145, five minutes' walk from Caulfield station. Phone 1300 852 050.

See volume enhancing treatments, before and after, non-surgical nose augmentation, or all face procedures.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.