Dissolving Dermal Fillers
Dissolving dermal fillers refers to the medical procedure of breaking down previously injected hyaluronic acid filler material using an enzymatic agent called hyaluronidase. This procedure offers a solution for patients who experience disappointment, for personal or aesthetic reasons, or medical concerns following cosmetic filler injections. The ability to dissolve fillers underscores the safety and flexibility of modern aesthetic medicine, providing patients with both reassurance and corrective options.
Hyaluronic acid (HA)-based fillers are the most commonly used and the most readily reversible. Hyaluronic acid is a naturally occurring substance found in the skin, joints, and connective tissue, which explains its compatibility with the human body.
Popular brands such as Juvéderm®, Restylane®, Belotero®, and Versa® are all composed of hyaluronic acid. When needed, these can be dissolved with hyaluronidase. Fillers made from other materials, such as calcium hydroxylapatite (Radiesse®), poly-L-lactic acid (Sculptra®), and polymethylmethacrylate (PMMA) (Bellafill®), cannot be dissolved in this way.
Several clinical and aesthetic indications may prompt the need to dissolve dermal fillers:
- Aesthetic dissatisfaction: Sometimes, the final appearance after filler injection does not meet patient expectations. This can include unnatural contours, puffiness, or an overly augmented appearance.
- Irregularities and asymmetries: Uneven filler distribution, lumpiness, or visible product under the skin can create an unnatural texture or uneven symmetry that patients wish to correct.
- Filler migration: Over time, filler material can move away from the intended injection site. Migration can cause alteration of facial features, particularly around dynamic areas like the lips, cheeks, and tear troughs.
- Desire to return to a natural appearance: Some patients, especially after many years of filler use, may wish to dissolve existing fillers to achieve a more natural, age-appropriate look.
The primary agent used to dissolve hyaluronic acid-based fillers is hyaluronidase, a naturally occurring enzyme that catalyzes the breakdown of hyaluronic acid. The body makes this enzyme naturally which accounts for natural degradation of hyaluronic acid fillers over time.
But when the results are not as expected or there is another circumstance, the enzyme is available as a medication to dissolve the filler.
When injected into the area where filler is located, hyaluronidase breaks the chemical bonds in the hyaluronic acid chains. This process rapidly reduces the viscosity and structure of the filler material, allowing the body to absorb and eliminate it naturally through its lymphatic system.
The enzyme acts quickly, often producing noticeable effects within minutes to hours, although full resolution of the filler can take up to 48 hours or more. Sometimes more than one treatment session is necessary, especially if large volumes of filler are involved or if the filler was cross-linked (a process that makes hyaluronic acid more resistant to breakdown).
The process of dissolving dermal fillers is generally straightforward and performed in a clinical setting:
- Consultation: A thorough assessment is essential. Dr. Shagalov must determine the type of filler used, the amount injected, its location, and any complications present.
- Preparation: The area is cleansed, and a topical anesthetic or local anesthetic injection may be applied to minimize discomfort.
- Injection of hyaluronidase: Using a fine needle or cannula, she will inject small amounts of hyaluronidase directly into or around the area containing the filler.
- Observation: Patients are monitored for an initial response to ensure the dissolving process is proceeding as expected.
- Post-procedure care: Patients may experience swelling, redness, and minor tenderness after the injections, but these effects are generally temporary and can be treated at home by following Dr. Shagalov’s instructions.
- Follow-up: A follow-up appointment is often scheduled to assess the outcome and determine if additional hyaluronidase treatment is necessary.
While dissolving fillers is considered safe, certain risks and side effects are associated with the procedure:
- Swelling and bruising: Mild to moderate swelling and bruising at the injection sites are common but typically resolve within a few days.
- Incomplete dissolution: In some cases, residual filler may remain, requiring further sessions for complete removal.
Patients should understand that while hyaluronidase effectively dissolves hyaluronic acid fillers, it is very difficult to just dissolve a little of the filler. Thus, it is important to discuss your concerns and options with Dr. Shagalov. Also it is important to understand that hyaluronidase cannot dissolve fillers made of other substances.
At a Glance
Dr. Devorah Shagalov
- Double Board-Certified Dermatologist
- Fellowship-Trained Mohs Micrographic Surgeon
- Recipient of numerous dermatology awards
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