Filler Dissolving

What is dermal filler dissolving?

Occasionally dermal fillers need to be dissolved and in Aesthetic medicine we use a prescription only medication called Hyaluronidiase (Hyalase) to do this. Potential reasons for dissolving dermal fillers include the following:

Unacceptable treatment outcome (e.g., overfilling, lumps, asymmetry etc)
Filler migration
An adverse/allergic reaction to the filler
Vascular occlusion and/or impending necrosis (tissue death)
Infection
Delayed onset nodule/immune reaction

If you’ve had a treatment elsewhere that you are not happy with, we usually recommend returning to your original practitioner for management (unless in an emergency e.g. vascular occlusion). Nonetheless, we understand that this may not always be possible for various reasons and in this circumstance would be happy to arrange a consultation with you.

What is hyaluronidase?

Hyaluronidase is a prescription only medication, licensed and commonly used to boost absorption or dispersal of drugs injected into the skin and has an off license use in aesthetic medicine. Hyaluronidase has an off license use in aesthetic medicine which is to dissolve hyaluronic acid-based fillers.

What does the procedure involve?

Patients are required to undergo a skin test at least twenty minutes prior to the procedure being undertaken (apart from in the event of an emergency). The skin patch test is carried out by injecting hyaluronidase into the subcutaneous tissue of the forearm and observed for signs of reaction (i.e., hives or wheals). If a positive test result is observed, treatment with hyaluronidase cannot be carried out. Redness and slight swelling may be expected.

If a negative result is observed then the relevant area is demarcated, numbing cream is applied and the dissolving enzyme is injected to break down the filler. The area will then be massaged to ensure even distribution of the product.

How soon can you see a result?

Results are generally noticeable within the first 24 hours, nonetheless, it can take up to 2 weeks. Occasionally the procedure may need to be repeated if the desired outcome is not achieved.

Are there any risks involved with hyaluronidase?

Hyaluronidase is an enzyme that breaks down hyaluronic acid fillers but, in the process, it can also break down the naturally occurring hyaluronic acid present in the body. Although the body’s own hyaluronic acid does eventually regenerate itself, in the interim this may cause volume loss and skin laxity in specific areas.

There is a rare risk of an allergic reaction to hyaluronidase (including anaphylaxis which requires immediate medical attention). Allergic reactions occur at a frequency of 0.05% – 0.69%. Signs of an allergic reaction include prolonged redness, swelling, itching and/or hardness, bumps in the skin. Such signs may appear at some or all injection points or in the general area the hyaluronidase has been injected. If you have allergic-type reactions to bee and wasp stings, you are more likely to have a reaction to hyaluronidase.

After the treatment some other common injection-related reactions might occur, including redness, swelling, pain, itching, bruising and tenderness at the injection site. They have generally been described as mild to moderate and typically resolve spontaneously a few days after injection. Ice, arnica cream and analgesics such as paracetamol can be used to manage these side effects.