A reassuring feature of modern hyaluronic acid dermal fillers is that they can be dissolved. But that doesn't mean reversing a treatment should ever be regarded as routine.
One of the questions patients sometimes ask before having dermal filler treatment is “Can fillers be removed?”
The short answer is yes, provided the filler is made from hyaluronic acid. However, there are a few important things worth understanding.
For more useful information and advice see our Dermal Filler Treatment page.
How Are Dermal Fillers Dissolved?
Most modern dermal fillers contain hyaluronic acid, a substance that occurs naturally in our skin and other tissues.
Hyaluronic acid fillers can be broken down using an injectable enzyme called hyaluronidase, often referred to by its original brand name Hyalase.
Hyaluronidase works by breaking down the hyaluronic acid molecules within the filler, allowing the body to absorb the resulting fragments.
The effects can begin surprisingly quickly, although the final result may take a few days to properly assess. Occasionally, more than one treatment is required.
Importantly, not all dermal fillers can be dissolved in this way. Products containing substances such as calcium hydroxylapatite (Radiesse) or poly-L-lactic acid (Sculptra) cannot be reversed using hyaluronidase.
Does Dissolving Filler Mean Removing All of It
Not necessarily. Hyaluronidase can be used to reduce the amount of filler in a particular area rather than attempting to remove it completely.
In my own practice, I very rarely need to dissolve dermal fillers. When I do, it is usually to make a small adjustment to filler volume, using carefully measured, small amounts of dilute hyaluronidase.
This can sometimes be sufficient to refine a result without losing the overall benefit of the original treatment. However, the response to hyaluronidase is not perfectly predictable, and precise control over how much filler is dissolved cannot be guaranteed.
Complete removal is exceptionally uncommon in my practice. The few occasions when I have needed to remove filler entirely have involved patients who have received treatment elsewhere and are unhappy with the result.
Is Dissolving Dermal Fillers Safe?
Hyaluronidase has been used in medicine for many years and is an important tool in aesthetic practice. Nevertheless, it is not entirely without risk.
Allergic reactions can occur occasionally including serious reactions. There may also be temporary swelling, redness or bruising following treatment. Quoted incidence of allergy varies, but a figure of 1 in 2,000 (0.05%) is not unreasonable.
Hyaluronidase can affect naturally occurring hyaluronic acid in the surrounding tissues as well as the injected filler, although the body's own, natural hyaluronic acid is rapidly replenished.
For these reasons, dissolving filler should be regarded as a medical procedure requiring appropriate assessment and clinical judgement, rather than a simple cosmetic adjustment.
There is also an important distinction between dissolving filler for cosmetic reasons and using hyaluronidase urgently to manage a suspected vascular occlusion. The latter is a medical emergency requiring immediate treatment.
Read here about Dermal Filler safety.
Getting It Right in the First Place
The availability of hyaluronidase is undoubtedly reassuring. But I have never regarded it as a substitute for careful assessment, conservative treatment and good injection technique.
At The Cosmetic Doctors Company in Esher, Surrey, our approach to dermal fillers is to restore volume and improve facial proportions without creating an obviously treated appearance.
That begins with understanding what a patient hopes to achieve, recognising when filler is appropriate and just as importantly, knowing when less treatment, or no treatment, is the better option. Read how to make sure your dermal filler results look natural?
The fact that a treatment can be reversed should never make us less careful about performing it.