Last Updated January 2023
What are hyaluronic acid and hyaluronidase?
Hyaluronic acid is naturally found in our connective tissue, skin, and nerve tissues. It acts as a ‘cushion’ or ‘lubricant’ for these tissues as it is a very water-loving molecule. Also naturally occurring in our bodies is the enzyme hyaluronidase, catalysing hyaluronic acid’s breakdown. The constant production of hyaluronic acid and subsequent breakdown with hyaluronidase means that one-third of our body’s hyaluronic acid is turned over daily.
Because of its properties, many dermal fillers are created from hyaluronic acid. The hyaluronic acid in filler is produced through bacterial fermentation and subsequent purification. Cross-linking these hyaluronic acid chains creates fillers with a gel-like consistency. Hyaluronic acid dermal fillers are commonly used to treat lines, folds, and wrinkles and to enhance or volumisation of cheeks, temples, lips, chins and jawline and are among the most popular non-surgical procedures worldwide currently. Traditionally, they have been said to be ‘temporary’ and only last from 6 to 18 months. However, a recent finding in 2019 by Dr Mobin Master is that hyaluronic acid dermal fillers last significantly longer. This was a finding from MRI scans of patients who had fillers many years ago. In his published study, of the patients studied, their fillers were found to last 2 to 12 years on MRI.
Although naturally found in the body, hyaluronidase can be produced to dissolve or reverse hyaluronic acid dermal fillers. Hyaluronidase is the only true ‘anti-dote’ to hyaluronic acid fillers, and given the potential longevity of dermal fillers, its role in cosmetic medicine is vital for the correction of unwanted aesthetic effects or complications from filler.
What is hyaluronidase used for in cosmetic medicine?
Outside of cosmetic medicine, hyaluronidase is used to temporarily break down the hyaluronic acid in connective tissue to help spread local anaesthetics or other drugs. In cosmetic medicine, hyaluronidase dissolves hyaluronic acid dermal fillers placed incorrectly or excessively. It is also used in emergencies to reverse dermal filler that has been inadvertently injected into an artery. The action of hyaluronidase is very quick and starts to work immediately on the dermal fillers. The fillers are permanently metabolised (dissolved). An example of hyaluronidase use is to dissolve dermal filler placed around the orbital (eye) region. Here, the skin is particularly thin, and overtreatment with dermal fillers is easily visible but readily corrected with hyaluronidase.
When can hyaluronidase be used after having filler?
Hyaluronidase can be used when there is a medical or aesthetic problem with hyaluronic acid fillers. This may be immediate or after the filler has been placed for some time and include the following;
- Filler misplacement – hyaluronidase can be used as an ‘eraser’ to correct misplaced filler immediately.
- Product migration – over time, when the filler has spread beyond the initial injection site
- Lumps or bumps – may appear immediately or weeks or months after the treatment.
- Overcorrection – caused by excessive filler treatment or too frequent filler treatment
- Vascular occlusion – when filler is inadvertently injected into an artery, the blood supply to the tissue it supplies is compromised. Hyaluronidase can be injected into the area to dissolve the filler and relieve the occlusion. Having hyaluronidase on hand during dermal filler treatment may help prevent adverse outcomes due to intra-arterial injection of fillers. Intra-arterial injection of dermal fillers can cause serious complications, including the death of the skin (causing scarring) and blindness. Hyaluronidase can be quickly injected into the occlusion area to re-establish blood supply and help avoid complications.
What can hyaluronidase dissolve?
Hyaluronidase permanently dissolves hyaluronic acid fillers by breaking the cross-linking (bonds) between the filler hyaluronic acid chains, leading to permanent removal.
Dissolving lip filler
Lip filler is a popular cosmetic procedure to volumise lips. Because of this, many have inadvertently overfilled their lips or have been injected too frequently. Fortunately, hyaluronidase treatment is effective in reversing this issue. For lips that have been overfilled, it is possible to use hyaluronidase to ‘reset’ the lips before refilling with a more appropriate amount of filler or simply to return them to normal.
Small lumps caused by lip filler injections can also be corrected by injecting hyaluronidase. Massaging lumps, in most cases, will not correct the problem, and more often, hyaluronidase will be required.
Migration or misplacement of lip filler outside of the vermillion (the red part of the lips) is another reason to dissolve filler with hyaluronidase. Filler placed outside the vermillion tends to create a ‘ducky’ and unnatural-looking lip.
Dissolving cheek filler
Dermal fillers can help shape and revolumise lost volume in the cheek. Common reasons for having cheek fillers dissolved include;
- accumulation of filler in the cheek after repeated treatments
- swelling or puffiness around the eyes from cheek filler
- lumps in the cheek, uneven or asymmetrical cheek filler
- excessive filler over the zygoma (lateral cheek), causing a Maleficent-like appearance
- ‘puffy faced’ appearance as a result of cheek overfilling and obstruction of lymphatics in the area by dermal filler
By dissolving previously injected cheek filler, it is possible to regain the natural shape of the cheek and reduce any puffiness caused by excess filler.
Dissolving tear trough filler
Overfilling the tear trough may result in puffiness of the lower eyelid, a common concern for those previously treated with filler in this area. Often, this may present several years after the initial tear trough filler treatment.
A blue-grey discolouration, known as the Tyndall effect, may also result from superficially placed filler in the tear trough and similarly requires hyaluronidase to treat.
Filler injected into the tear trough may inadvertently be injected post-septal or underneath the eye. This may be difficult to dissolve unless hyaluronidase is injected into the same area. For tear trough filler that persists despite hyaluronidase treatment, an MRI scan may be required to determine the location of the filler and if it has been placed post-septal.
Dissolving nose filler
Nose filler can address concerns like bumps, irregularities on the nasal bridge, an uneven/unbalanced nasal appearance or a flattened nose. However, as nose filler flattens and spreads from its initial placement, the perceived ‘lifting effect’ may dissipate. Despite this process only taking a few months, the filler may remain in situ for many years in the nose. Naturally, more filler may be injected to recapture the initial results, despite the filler remaining. An accumulation of nose filler often occurs, causing the nose to increase in width. Hyaluronidase injected in the nose can help to remove previously injected hyaluronic acid filler and reverse this concern.
Dissolving chin filler
Chin filler can create a more defined jawline and improve the appearance of a person’s side profile. In cases of repeated filling or misplacement of filler, it is possible to have a chin that appears too broad, or ‘witchy’. Furthermore, there is a small chance of chin filler migration into the neck, accentuating the fullness there. These concerns can be corrected through the injection of hyaluronidase.
What can I expect when dissolving fillers?
Dissolving filler is normally straightforward and usually only requires 1-2 sessions. However, if a resolution is not achieved with two sessions of hyaluronidase, it may be prudent to perform an MRI to determine if the filler is still present or if there is another concern.
If the filler is not hyaluronic acid, it cannot be dissolved with hyaluronidase.
Furthermore, if the filler has become hard in consistency, another diagnosis may need to be considered, such as granuloma or delayed type IV hypersensitivity. These concerns are not usually corrected with hyaluronidase as they are immune reactions to the filler.
How to prepare for dissolving fillers
Before your fillers are dissolved, you will have a consultation with a practitioner to determine your goals and ensure you’re fully informed about what may happen. They will also discuss the cost of treatment.
The practitioner may also do a patch test on your arm to check for allergies or sensitivities.
Filler dissolving process
The dissolving treatment itself will usually only take a few minutes.
The practitioner will inject the hyaluronidase into the area where the unwanted filler is located and may gently massage the injection site to ensure even distribution. If there is a strong reaction, such as swelling or redness, you may be required to remain in the clinic before leaving to ensure this does not progress to anaphylaxis (although the risk of this is very small).
Filler dissolver treatment aftercare
You may experience some bruising and swelling for a few days after treatment.
Many patients who have overfilled, especially those who have been overfilled for a prolonged period and then dissolved, are often unprepared for the change in their appearance post-hyaluronidase. The skin may appear more wrinkled, deflated, or loose, often within a day of having hyaluronidase injected. These differences may be more magnified the longer the filler has been in situ. It is important to remember that hyaluronidase does not permanently affect your natural hyaluronic acid and only permanently removes filler. Skin laxity, crepiness, or wrinkling may be due to a loss of volume from filler being removed. Changes to the skin due to the absence of filler may need to be corrected with energy-based devices or surgery to tighten the skin.
In the rare event (1/2000 cases) you should experience the symptoms of anaphylaxis, such as trouble with breathing, swallowing, wheezing, or tongue swelling, you should seek urgent medical attention.
How many treatments are required?
One or two hyaluronidase treatments are usually adequate to dissolve or remove the hyaluronic acid dermal filler. In rare situations, multiple treatments of hyaluronidase may be required to dissolve the filler. This may be due to either an inadequate dosage of hyaluronidase or injection of hyaluronidase into the wrong area.
If there is doubt that the filler has not been dissolved after several hyaluronidase treatments, it may be prudent to perform an MRI to detect whether the filler is present in the area in question.
What are the possible side effects of hyaluronidase?
Injection-related side effects, including swelling and bruising, are hyaluronidase’s most common side effects.
Allergy, including anaphylaxis, is an uncommon side effect of hyaluronidase injections and has been purported to occur in 1 in 2000 cases. We may perform a test patch before the hyaluronidase treatment, especially for those with a history of allergies, including allergy to bee stings. Supposedly, anaphylaxis to hyaluronidase is more prevalent in those who are allergic to bee stings, as hyaluronidase is also contained in bee venom.
The most difficult aspect of using hyaluronidase is judging the amount required to dissolve the filler. It is quite easy to over or under-dissolve. Therefore, a second or third visit may be required to add more filler if over-dissolved or to retreat with more hyaluronidase if under-dissolved.
Frequently asked questions about dissolving fillers with Hyaluronidase
Can all dermal fillers be dissolved?
No. Only dermal fillers made from hyaluronic acid can be dissolved with hyaluronidase. Other semi-permanent and permanent fillers cannot be removed with hyaluronidase.
Hyaluronic acid filler that has become hard in consistency may require treatments other than simply hyaluronidase. The change in consistency of the filler may indicate granuloma formation or a delayed type IV hypersensitivity reaction, which is an immune-mediated response to the filler and requires other treatment.
Does hyaluronidase dissolve natural hyaluronic acid?
Hyaluronidase injections are highly targeted, so they will dissolve hyaluronic acid filler before they dissolve any natural hyaluronic acid.
Our skin and tissues are not broken down by injected hyaluronidase, however. Because our natural hyaluronic acid is turned over constantly by naturally occurring hyaluronidase, the effect of injected hyaluronidase on our body’s natural hyaluronic acid is temporary.
How long does filler take to dissolve with hyaluronidase?
Hyaluronidase has an immediate effect. At times, the effect will be noticeable immediately. However, because of the injecting process, the area’s swelling may not make the effects of hyaluronidase apparent immediately.
It is difficult to determine the amount of hyaluronidase to administer, and if an inadequate amount of hyaluronidase has been injected, a subsequent session may be required. The location of the previously injected filler may be difficult to determine precisely, and subsequent hyaluronidase treatments in different depths or locations may be required to target and dissolve the filler.
How soon after hyaluronidase can I get filler again?
Ideally, it is best to wait at least a week after dissolving your filler to replace it with new filler. This allows any swelling to go down and ensures that the hyaluronidase does not dissolve the new filler.
Where can I get my filler dissolved in Melbourne?
The doctors and nurses at the Victorian Cosmetic Institute Melbourne are highly experienced in dissolving hyaluronic acid fillers using hyaluronidase. If you have a concern with your dermal filler that may require correction, we may be able to help.
Contact us at 1300 863 824 today or book online to get started.