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 $-$$
Reversing Dermal Fillers 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 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?
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.
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.
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).
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What are the side effects of dermal filler dissolvers?
Expected side effects include swelling and bruising for up to 2 weeks. This is proportion to the amount of HA filler dissolved & the site of injection. Other side effects include –
- Allergy to the enzyme (Hyaluronidase). This cross reacts with bee stings
- As above. Redness, itch, swelling, trouble breathing. This is why it is paramount to perform this procedure in a medical facility
- Asymmetry and volume loss IS EXPECTED as the enzyme targets injection based hyaluronic acid dermal fillers
How many sessions may I require to dissolve my dermal filler?
Typically, 1-3 sessions. This depends on-
- The location of filler
- The amount placed (Volume- number of syringes)
- The type of hyaluronic acid filler (Brand)
- The dilution- enzyme International Units
- Your immune status
Is this treatment painful?
Hyalase diluted in normal dilutions is painful, this is why we dilute this in Xylocaine, a local anaesthetic mix. In some cases (such as dissolving lip fillers), we perform a nerve block prior to the injection if required.
Are there any side effects to dermal filler reversal injections?
Swelling is universally seen, bruising is common. This is proportion to the amount of filler that requires dissolving. Other reported side effects include-
- Hives, urticaria, itch, swelling
- Systemic side effects such as breathing difficulties are rare
Hyalase injections should ALWAYS be performed in a medical environment with trained resuscitation staff & adrenaline on hand. This enzyme has a cross reaction with bee stings.
How long does swelling last following Hyalase injections?
Swelling takes approximately 2-4 days to settle down. This is proportional to the amount of filler dissolved. In some cases, we do give oral prednisone for 48 to 72 hours to reduce the amount of swelling.
What are the other options if I do not like the results of my dermal filler?
Hyaluronic acid fillers dissolve with time. The time taken will depend on many factors including the location of filler (eg. lip fillers will dissipate faster cf. temple fillers), the brand of dermal filler (eg. Juvederm Volbella last a long, long time in the tear trough area), and your activity (high level athletes, long distance runners metabolise fillers faster). The most important factor to consider is your own immune system. As a rough guide longevity of dermal HA based fillers are as follows –
- Lip fillers 12 months
- Under eye fillers 6-18 months
- Cheek fillers 18-36 months
MRI scans can pick up residual dermal fillers with accuracy. MRI scans are covered by Medicare only if there are associated medical concerns (delayed nodules, infection, abnormal migration, etc…), & not through routine scanning.
Will my own natural collagen dissolve with Hyaluronidase?
Accurate placement of Hyalase will only target hyaluronic acid fillers. This is why it is important to have as much information as possible prior to dissolving dermal fillers. The two weeks following the procedure can be daunting as you will be volume depleted. The amount of volume depletion is dependent on your past history of fillers.
There is a theoretical risk that too much hyaluronidase in the incorrect location may affect your own hyaluronic acid (hence why the primary injector should ideally perform this procedure).
Can one partially dissolve dermal fillers?
Focal or local filler dissolving is possible, however the majority of patients will require a few sessions (2-4). It will also depend on the area and volume of filler. Discuss this option with your treating injector.
How can I get my filler dissolved?
Ideally your injector who performed your dermal filler should give you the option of managing any potential concerns. This viewpoint is based upon professional practice.
If you would like me or my clinical staff to handle this, please book in for a consultation. To help us manage your case we do require accurate information including –
- The type of dermal filler injected – brand and class (eg. Juvederm, class Voluma)
- The AMOUNT of filler injected (in mls or number of syringes)
- The EXACT location of filler (eg. Upper lip, tear tough). Your injector will have a record.
- All dates of your filler sessions. This includes fillers performed in the distant past.
- Your medical history, including any allergies, history of allergies to bee stings.
- Any imaging including MRI and or ultrasound scans.
- Any relevant medical history
For elective filler dissolving, please book in with my clinical nurse injector at Clinic Cutis.
For medical filler reactions including arterial-vascular compromise, cases of suspected infection, delayed nodules etc please arrange a referral for a consultation with myself. If required I will arrange imaging such as MRIs, culture, PCR etc
Vascular occlusion should be managed immediately by your injector as this is a medical emergency.
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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