Dermal Filler Reversal Hyalase / Hyaluronidase

Reversing Dermal Fillers Hyalase / Hyaluronidase At A Glance

  • Best Results1-2+ sessions
  • Treatment Recovery1-4 Days
  • Procedure Time20 min
  • Skin SpecialistDermatologist, Nurse Injector
  • Duration of ResultsLifelong in most
  • AnaestheticLocal anaesthetic
  • Back to WorkImmediate - 4 Days
  • Cost $-$$

Dermal Filler Reversal Hyalase / Hyaluronidase

Occasionally dermal fillers may require dissolving. This may be due to incorrect placement, lumps & bumps, poor results, filler migration, dermal filler side effects, accumulation of hyaluronic acid, or simply changes in aesthetic trends (lips!) Your injector is your first port of call. If they are not confident in reversal of hyaluronic acid filler; or managing one of many dermal filler side effects a dermatologist or plastic surgeon can help.

FactsFacts on Dermal Filler Reversal

  • Hyaluronic acid dermal fillers can be reversed with a special enzyme
  • The most frequently dissolved sites include the lips, cheeks, & under-eye area
  • Hyalase or hyaluronidase is the enzyme used to reverse fillers
  • In most cases reversal can be completed in one session
  • In some cases, reversal requires many more sessions
  • Recovery can take up to a week or more, depending on the volume reversed

What type of dermal fillers can be reversed?

Dermal Filler Reversal

All hyaluronic acid fillers can be erased. These include Juvederm, Boletero, Restylane & Redensity.

Poly-L-Lactic acid (Sculptra) & Calcium Hydroxyl Apatite (Radiesse) cannot be reversed with hyaluronidase, however, there is some evidence that sodium thiosulfate may partially ‘reverse’ the latter.

HA fillers including Juvederm, Restylane & Belotero can be dissolved with injections.

How long does it take for Hyalase - Hyaluronidase to work?

Immediately. Hyaluronic acid is exquisitely sensitive to Hyalase and breaks down immediately. The half-life of this enzyme is very short, hence by 12-24 hours the results are maximal. We normally wait a few days to one week to reassess if you require further injection as there is often swelling post injection.

There is a marked difference between dissolving hyaluronic acid & collagen.

How soon after hyaluronidase can I get dermal fillers?

No earlier than two weeks after the last Hyalase injection. This allows for swelling & bruising to settle, this gives for the most accurate placement of subsequent injections.


What sites are most frequently dissolved?

The tear troughs, cheeks & lips are the most frequently treated sites. Too much filler, & or HAs placed too superficially will result in the Tyndall effect under the eyes. Tyndall occurs when the skin overlying the filler is blue (due to reflection of longer red wavelengths).

Blue under your eyes? Probably Tyndall. Filler in the trough area has to be placed precisely & conservatively.

Dr Davin Lim on Hyalase / dermal filler dissolving enzyme

With the event of dermal fillers, specialists are seeing more dermal filler reactions & complications. Hyaluronic acid fillers can be reversed with a special enzyme called Hyalase or hyaluronidase. The majority of patients will require only one session, however, multiple treatments may be required for ‘higher viscosity’ HA fillers.

Test spots are required for elective dissolving as this enzyme has a cross-reaction with bee stings. Emergency dissolving is indicated for confirmed or suspected cases of vascular compromise.

The vast majority of dermal filler reactions do not require reversal (the exceptions are vascular compromise or infection). Delayed nodules (lumps or bumps weeks, months, or years after injection) will usually resolve with adequate anti-inflammatory medications. This is most likely due to a cross antigen such as after a cold-flu-sore throat, injections, Covid vaccinations, etc…

My standard protocol is to reconstitute hyaluronidase with xylocaine, as injections can be painful. My injection units vary between 30 to 500 IU, depending on the indication. For elective filler dissolving, arrange a consultation with my nurse injector @cliniccutis. For URGENT medical cases, complex cases, delayed nodules, & cases of suspected infection, I am more than happy to review your case. Your referring doctor will contact me.

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