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].
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
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If you are truly unhappy with the result
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You develop lumps and bumps called late-onset nodules.
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The filler has migrated.
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The filler is visible under the skin as a line.
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You have a blue tinge to the skin (this is called the Tyndall effect)
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You have swelling [oedema]
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]
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.
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:
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