Filler Dissolving

What is it?

Filler dissolving is the breaking down of a hyaluronic acid-based filler by applying the enzyme hyaluronidase. It is used for filler that you do not like, find excessive, that has remained asymmetric or that has settled in the wrong layer; it is also the basis of emergency treatment in the event of a vascular complication.

Most people who reach this page are unhappy with a result from treatment done elsewhere. So two things need to be made clear from the start: not every filler dissolves, and dissolving is not a risk-free procedure in its own right.

Hyaluronidase is an enzyme that breaks down hyaluronic acid. When it is delivered into an area that has been treated with filler, it disrupts the structure of the gel and speeds up its clearance from the tissue. The effect usually begins quickly, but the result can take time to settle fully, and complete dissolution is not always achieved in a single session; the amount of enzyme needed varies with the cross-link density of the gel, the volume that was injected and how much time has passed. There is a second point you need to know: the enzyme does not distinguish between the filler that was injected and your body's own hyaluronic acid. The natural hyaluronic acid in the area is also temporarily affected, which is why the area can look more sunken than it really is for a short time after dissolving. This reverses, but it is unsettling when it is not expected, and it has to be explained beforehand. The situations in which the enzyme does not work also need to be known from the outset: biostimulators such as calcium hydroxylapatite and poly-L-lactic acid, and fillers described as permanent, are not dissolved by hyaluronidase.

Which filler do you have? That is the first question to ask

When someone comes with filler done elsewhere, the most critical piece of information is which class the injected product belongs to. If it is hyaluronic acid, it can be dissolved; if it is a biostimulator or a permanent filler, hyaluronidase will not work and a different route is considered. Patients often do not have this information. If you have a treatment record, a product label or an invoice, bringing it makes the process noticeably easier. Without a record, the assessment relies on the examination findings and your history; certainty is lower in that case, and you are told so plainly. Another common situation is that the area may have been treated more than once, in different places and with different products. In such an area, expecting a complete result in a single session is not realistic. The process moves forward gradually and is guided by interim assessments.

1. Identification: the class of the injected filler is assessed from your history and any record available.
2. Test: where considered necessary, a preliminary assessment of sensitivity to the enzyme is carried out.
3. Treatment: the enzyme is delivered to the target area in controlled amounts.
4. Interim assessment: the area is reviewed once the result has settled; an additional session is planned if needed.

Treatment Areas

• Lips — an excessive or asymmetric result
• Nose — the wrong layer or an unwanted contour
• Under the eyes — puffiness or a bluish appearance
• Chin and jawline — excess volume
• Not possible: calcium hydroxylapatite and poly-L-lactic acid treatments
• Not possible: fillers described as permanent

Procedure Steps

1. History and records

   You are asked which product was injected, when, and into which area. Any treatment record, product label or invoice is reviewed; if there is no record, you are told plainly that certainty is lower.

2. Assessing the filler class

   Whether the injected filler is hyaluronic acid is assessed. If it is not, you are told at this stage that hyaluronidase will not work, and the procedure is not carried out.

3. Medical history

   Allergy history, the medicines you take, pregnancy or breastfeeding, and any active infection in the area are asked about.

4. Treatment

   The enzyme is delivered to the target area in controlled amounts. Where considered necessary, it is done in stages.

5. Assessment

   The area is reviewed once the result has settled. Complete dissolution is not always achieved in a single session; an additional session may be needed.

Duration and Longevity

The outcome of dissolving cannot be undone: gel that has been dissolved does not come back. What is temporary here is the sunken look that appears because the natural hyaluronic acid in the area is also affected; this improves over time. How long the process takes and how many sessions are needed vary with the structure of the gel, the volume injected and the time that has passed. If further filler is being considered after dissolving, you need to wait for the area to recover; that interval is set by the physician's assessment.

Who is it suitable for?

• People who are unhappy with a hyaluronic acid-based filler
• People who come with an excessive or asymmetric result, or with filler that has settled in the wrong layer
• People who have a treatment record or product information
• People who accept that the process may be gradual
• People whose area needs to be cleared before surgery

Who is it not suitable for?

• People who have had a filler other than hyaluronic acid — the enzyme has no effect on these products
• People who have had a filler described as permanent
• People with a known hypersensitivity to hyaluronidase
• People with an active infection at the treatment site
• Pregnant and breastfeeding people (a physician's assessment is needed)
• People who come believing the procedure is entirely risk-free: dissolving is a medical procedure in its own right, has its own side effects and also temporarily affects the natural hyaluronic acid in the area.

Aftercare

• You can apply cold to the area intermittently during the first 24 hours.
• Do not massage or press the area yourself.
• The area may look sunken in the first days; this is because the natural hyaluronic acid is also affected, and it is temporary.
• Wait for the swelling to resolve before judging the result.
• If you are considering filler again, do not plan it yourself; the waiting period is set by the physician's assessment.
• If there are signs of an allergic reaction, such as widespread redness, itching or shortness of breath, seek medical care immediately.

Possible Side Effects

• Temporary swelling, redness and bruising
• A temporary sunken look in the area — because the natural hyaluronic acid is also affected
• More dissolution than expected — the filler may break down beyond the intended amount
• Complete dissolution not being achieved in a single session; an additional session may be needed
• Rare: an allergic reaction to the enzyme. Because of this possibility, the procedure is carried out in suitable conditions and with preparation in place.

Frequently Asked Questions