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Dissolving your dermal filler

When would you need your dermal filler dissolving?

The advantage of using hyaluronic acid as a face filler is that it can be dissolved using an enzyme called hyaluronidase [Hyalase]

Image by Ian Taylor

As an emergency

A filler-dissolving enzyme such as hyaluronidase is needed if the filler causes a reduced blood supply to an area of the face.​ This is called vascular occlusion and is regarded as an emergency to prevent the death of skin tissue [necrosis].

Planned procedure

  • If you are truly unhappy with the result

  • You develop lumps and bumps called late-onset nodules.

  • The filler has migrated.

  • The filler is visible under the skin as a line.

  • You have a blue tinge to the skin (this is called the Tyndall effect)

  • You have swelling [oedema]

Image by Oli Dale

If you have a possible history of anaphylaxis to hyaluronidase or wasp/bee stings, you will need a  test at a specialist allergy centre beforehand

Dissolving Filler If Your Are Overfilled

Having too much filler can give you un-natural looking results. Injectors may feel obliged to use a full syringe rather than stop. Overfilling can lead to later problems, such as filler migration and nodule formation. If you feel you have had too much filler, in the first instance, it is advised to go back to your original practitioner who should be able to help you. If you don't feel you can, we may be able to help correct the problem or give you impartial advice.

Choices Available

HYALURONIDASE [AN ENZYME OR DISSOLVER]

ALLOW THE FILLER TO DISSOLVE NATURALLY [SAFEST]

Do Nothing

Hyaluronidase

Image by DiamondRehab Thailand

Do nothing

Image by Alexander Krivitskiy

How hyaluronidase works

Dermal fillers are made up of hyaluronic acid (HA). Hyaluronic acid is found throughout the body, supporting the tissues and maintaining hydration as it attracts water. 50% of the body's total hyaluronic acid is contained in the skin.

 

HA is thought to be a key molecule in the ageing process, which is associated with a loss of moisture. HA is broken down by the body's own hyaluronidases. One molecule of HA only lasts one to two days in the skin and is continually replaced by new HA.

 

Synthetic dermal fillers use a synthetic hyaluronic acid, which is cross-linked during its manufacture. You may have heard differing technologies to do this, and this process gives the dermal filler resilience to breakdown. The main crosslinker used is called BDDE. Some dermal fillers are mixed with non-crosslinked HA and are called biphasic. As a rule, the more cross-linked the filler, the longer it lasts.

When dermal filler needs to be dissolved, it is possible to use a high concentration [or dose] of hyaluronidase to dissolve the crosslinks and then the hyaluronic acid filler. There are at least 3 companies that make hyaluronidase with brand names such as hylenex, vitrase and hydase.

How is your filler dissolved with Hyaluronidase [Hylase]

As with your initial dermal filler, it is advisable to arrive without makeup. Your skin will then be cleaned.

 

Your injector will then prepare the hyaluronidase, which is supplied as a powder in a vial. This may or may not be mixed with local anaesthetic (LA). A topical cream can also be applied. Please be aware that this can still be a painful experience.

 

The amount of hyaluronidase injected can vary, although there are recent guidelines to help your injector that they should follow. It is also not an exact science, so you may need more than one attempt to remove the filler altogether.

 

For best results, especially if you have lumps and bumps,  you may need the filler to be dissolved under ultrasound guidance. Ask your injector if they will be using this.

 

Having an area of redness and swelling after the injection is entirely normal. You should be reviewed within 48 hours (2-3 days later)

Dissolving filler is an advanced procedure, so ensure your practitioner has adequate training and knowledge. Due to the small risk of a reaction, they should have up-to-date resuscitation skills and equipment readily available. We have oxygen, a defibrillator, emergency drugs and a consultant anaesthetist with over 25 years of experience dealing with anaphylaxis.

  • Where is the tear trough?
    The tear trough is a groove between the lower eyelid at the inner corner of the eye and the upper cheek. A tear trough deformity (or hollow) is not a deformity but is used to describe the deepening of this groove. This occurs as a typical result of ageing or may be inherited. It is caused by changes in the bone, fat and skin. It is one of the first areas of the face to show signs of ageing
  • How does dermal filler work in the tear trough area?
    As explained, the tear trough is a depression in the skin, which can cause abnormal shadowing and the appearance of dark circles. Dermal fillers work by creating a lifting effect and are injected in small volumes using a needle or cannula. Most dermal fillers are supplied in 1ml syringes; however, injecting more than this in one treatment session is not recommended. If additional correction is needed, this can be performed at a later treatment session which should be discussed during your consultation.
  • Am I suitable for tear trough treatment?
    You may not be suitable for treatment if you: Are pregnant or breastfeeding. Are undergoing IVF. Suffer from keloid scarring Have active skin conditions, such as infection, acne or psoriasis Are suffering from any other infection, including COVID. Are unwell on the day of treatment. Are taking any medicines which thin the blood, such as aspirin or warfarin. Have taken Roaccutane or isotretinoin for the past 6 months. Have certain allergies Have had recent facial surgery or other dermal fillers in the same area. Have permanent implants, such as silicone implants in the face or pins and plates. Tear trough treatment may also not be suitable if: The cause of the problem is predominantly pigmentation and dark circles. If you have prominent eye bags If you are prone to puffiness under the eyes. Your skin is very lax.
  • Can any filler be used to treat the tear trough?
    No. The eye is a sensitive area to treat, and some fillers are highly unsuitable, especially if they attract water. This can make the appearance of the tear trough much worse. You should only have a specific type of hyaluronic acid filler, such as Teosyl Redensity II or Juvederm Volbella. A less water-attracting [hydrophilic ] filler should be used in the tear trough to prevent the risk of creating too much volume and unsightly bulging. One size does not fit all. Another safe alternative is to use liquid platelets or a gel made from your platelets called a bio-filler.
  • How long does tear trough deformity treatment take?
    Treatment of the tear trough area will often take between 30-60 minutes to perform. Following your procedure, the practitioner may massage the area and clean the skin. Some practitioners might apply a cream post-treatment. After the treatment, your practitioner will book a follow-up appointment. You should also receive aftercare information either in paper form or electronically before or after your treatment.
  • Is injecting the tear trough deformity painful?
    This area may be sensitive during the injection. Most dermal fillers contain a local anaesthetic which lessens the discomfort as they are injected. Usually, a topical anaesthetic, such as LMX4 or Emla™, is used to provide additional pain relief. This will be applied to the skin and left on the surface for 20-40 minutes. Also, your injector may be able to offer you a nerve block. Once the anaesthetic has worn off, there may be some expected tenderness. There should not be any significant degree of pain. If you are in much discomfort, you must contact your practitioner as this could indicate that you are developing a complication.
  • How long does tear trough filler last?
    Because the tear trough is not very mobile, it takes your body longer to dissolve the dermal filler naturally. Saying that longevity varies between products and between individuals. Most hyaluronic acid fillers will last between 6 months and 18 months.
  • What side effects should I expect after tear trough deformity correction?
    The common side effects after tear trough treatment are: Pain Minor tenderness or discomfort after your treatment is entirely normal. If you have more pain than expected, you must contact your treating practitioner immediately. Redness This is normal and usually resolves within 24 hours. If the skin becomes red and warm, this may indicate an infection. Again contact your practitioner straight away. Swelling [Oedema] Some swelling is normal after treatment and may worsen the next day. The tear trough is more prone to swelling than other facial areas. If the swelling persists, tell your practitioner. Bruising Bruising is common after tear trough injections. This can be anything from a small skin mark to extensive bruising that extends beyond the tear trough, such as a black eye. This can take up to 2 weeks to resolve. Rarely, bruising can lead to permanent staining of the skin. Infection SIgn s of infection include a warm, red, swollen area over the area that has been injected. This usually happens a few days after your treatment. If this happens, contact your practitioner for a review as soon as possible. Lumps and Bumps Lumps may be present immediately after treatment. This, to some extent, is normal. Bumps can also appear months later due to filler migrating. Lumps may appear as soft swellings or as hard nodules. If you develop a lump, ask your practitioner for a review. Extremely rare side effects are listed for completeness: Vascular Occlusion Occlusion or blockage of a blood vessel is a rare but severe complication from all dermal filler injections. A blockage results in an interruption of normal blood flow. If this is not correctly managed, the skin and tissue supplied by the blood vessel can die, resulting in scarring. It usually occurs immediately, so your injector should know immediately if this has happened. In most cases, this can be treated. Blindness This is another infrequent but devastating complication. If blindness occurs, it is likely to be permanent. Stroke Another extremely rare but documented complication of dermal fillers.
  • What should I do before my tear trough treatment?
    Ensure your practitioner is informed of any changes in your medical history or medication before receiving your injection. For one week before: Avoid sunbeds and tanning For 3 days before: Avoid taking anti-inflammatories (such as aspirin, ibuprofen, and naproxen) Avoid fish oils, St. John’s Wort, Ginkgo Biloba, garlic and Vitamin E If you are prone to bruising, taking arnica orally for a few days before treatment may lessen the risk, but this is not proven. Contact your practitioner before your appointment if: If you are unwell on the day of your appointment, contact the practitioner to reschedule. You have a social event and want to delay your treatment until after (usually, having the treatment two weeks before is sufficient to allow swelling or bruising to disappear). You cannot commit to a two-week review.
  • What is the downtime after?
    This varies depending on a few things; however, generally speaking, within 1 to 2 days, any swelling or redness should have subsided. Within a week, the signs of being injected should have entirely disappeared. Please not if you get a bruise. This can take up to two weeks to fully resolve.
  • What should I do and not do after my tear trough correction? [after-care]
    After treatment, most people can resume their normal daily activities. Some redness, tenderness and swelling at the injection sites are pretty normal. Bruising may be apparent immediately after treatment. The standard advice which is not proven is listed: Do not apply make-up for 12 hours after treatment (reduces the risk of infection). Avoid touching or rubbing the treated area. Until the swelling has settled: Avoid saunas, swimming pools and sunbeds. void extremes of hot or cold and vigorous exercise.
  • Is tear trough filler high risk?
    All treatments carry a degree of risk. All risks and complications should be discussed with you at consultation and before any treatment is agreed upon. Even though there are blood vessels in this area, the risk of a vascular injection is much lower than people or injectors think. Also, the risk of blindness is much lower even if the filler is injected into a vessel.
FAQ Hyalase

Further Information

Several excellent resources and information are available to decide whether dissolving your dermal filler is the right decision for you. These are independent, unbiased, and written by experts to provide you with all the necessary facts.

References:

Murray, G., Convery, C., Walker, L. and Davies, E., 2023. Hyaluronidase Guideline: Pharmacology, allergy and elective use.

Jimmy Faivre, Amos I. Pigweh, Julien Iehl, Pauline Maffert, Peter Goekjian & François Bourdon (2021) Crosslinking hyaluronic acid soft-tissue fillers: current status and perspectives from an industrial point of view, Expert Review of Medical Devices, 18:12, 1175-1187, DOI: 10.1080/17434440.2021.201432

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