There are a few situations where we might want to dissolve cosmetic hyaluronic acid fillers after they’ve been injected.
- The filler migrated or collected in an area that did not need any, and it looks out of balance or unnatural.
- The client decides they don’t like the appearance of the area after it was treated with filler and wants it removed.
- The rare occasion when someone injects filler into an artery and causes a blockage of blood flow to an area.
Fortunately, these are all uncommon scenarios, but it does make headlines when a celebrity comes out and says they got their filler dissolved. (Amy Schumer comes to mind.)
The most commonly used fillers in cosmetic medicine are made of hyaluronic acid (HA).
The treatment to dissolve hyaluronic acid fillers requires a local injection of an enzyme called hyaluronidase, brand name Hylenex.
Hyaluronidase is an enzyme that already exists naturally in the body, just like HA does.
Because it is an enzyme, it very specifically only breaks down HA, without harming any other tissues or parts of the skin or body. It won’t “melt” your face like a tabloid headline might read. It targets the HA only.
It doesn’t harm the native hyaluronic acid. Any loss of native HA is replenished by the body.
There can be a little swelling initially for 1-3 days as the filler becomes softer. It is then gradually reabsorbed over 7-14 days. Allergic reactions are uncommon, since Hylenex is a highly purified recombinant human enzyme and should not react like a foreign protein would.
The doctor might do a skin test on the forearm first to be sure you don’t have an allergic reaction to it. It takes about 15 minutes to test, usually while the numbing cream takes effect. Allergic reactions were more common when they used sheep-derived hyaluronidase but are rare now that human hyaluronidase is available.
The procedure is not painful; we use topical and local numbing if needed. It can have a slight burning sensation for a few minutes but overall is well tolerated by most patients.