How, When, and Why to Consider It

With more and more people opening up about the work they get done, getting injectables is no longer taboo. However, we've all heard the horror stories of filler that migrates or gives someone a lips akin to a puffer fish.

"There are various reasons why people would want to dissolve their filler," says Dr. Eman Abdallah, founder of Emana Medical in Beverly Hills. "Patients often get put on a filler injection schedule based on the how long we think the filler is advertised to last. However, what we don’t realize is that it can last much longer than we think. In many cases, patients don’t know when to stop, and many injectors don’t know when to just say no. Over time, over-filling lips, cheeks, chin, etc. can lead to asymmetry, bumps, and an unnatural appearance and patients end up want to go back to looking like themselves." 

Additionally, Dr.Edward Chamata, a Houston-based plastic surgeon, says another reason someone may consider getting their filler dissolved is if it caused some sort of complication, such as skin compromise and thus needs to be dissolved urgently so it doesn’t lead to serious complications like skin necrosis (death of the tissue).

It's not common, but if those filler faux-pas occur, know that there are ways to reverse their effects. Below, find everything you need to know about getting them removed — from which ones can be dissolved, which ones can't, what the process of doing so looks like, whether or not it hurts, and when you can get filler again should you choose to.

What types of filler can be dissolved?

Dr. Chamata says the only types of filler that can be dissolved are the ones that are hyaluronic acid-based, such as Juvéderm and Restylane.

"The way the hyaluronic acid is cross-linked at the molecular level dictates how thick or structured it can be, as well as how long it will likely last if injected properly. It also dictates how easily it can be dissolved," explains Dr. Abdallah, adding that thicker, heavily cross-linked filler may require multiple sessions of dissolving.

Non-hyaluronic acid-based ones are those that can't be dissolved. "PMMA filler (Bellafill), calcium hydroxylapatite filler (Radiesse), and poly-L-lactic acid filler (Scultpra) are all examples of fillers that cannot be dissolved.," shares Dr. Chamata.

What are the potential side effects of getting filler dissolved?

There are temporary side effects that can always occur with any type of injectable or in-office treatment, such as bruising, swelling, and discomfort. To minimize the possibilities of bruising or bleeding, Dr. Konstantin Vasyukevich, a board-certified dermatologist in New York City, says to avoid taking blood thinning medications, such as Aspirin, Advil, and Naproxen, prior to your appointment. And for post-care, Dr. Abdallah recommends taking either Arnica pills or applying an Arnica gel to the area to subside bruising and swelling.

When it comes to dissolving filler, Dr. Abdallah says the pain is caused by the enzyme that breaks down the old filler in your skin tissue. However, the amount of pain someone feels will be determined by their pain tolerance and what the treatment area is, as locations such as the lips have more nerves than others.

"Over-dissolving can also break down your body’s naturally occurring hyaluronic acid, so it is important to choose a provider who understands the facial anatomy as well as the physiology of the tissue as a result of the products being used," she urges.

What's the process of getting filler dissolved?

If you're prone to bleeding or bruising, you can take Dr. Vasyukevich's above advice and avoid blood thinners leading up to the treatment. Otherwise, no further prep is required on the patient's side.

Once you arrive to your provider's office, he says topical numbing cream or local anesthesia may be applied to the area to minimize discomfort. "Most patients would feel the needle pinch during the injection, but the discomfort is typically minimal," Dr. Vasyukevich adds.

The solution used to dissolve filler is called hyaluronidase, or hylenex. "This is an enzyme that breaks down the hyaluronic acid filler," explains Dr. Abdallah. "I typically like to inject no more than a 1:1 ratio of volume of the hylenex to filler volume if possible." However, the amount of solution injected can also be dependent on how old the filler is, as Dr. Vasyukevich says they're typically harder to dissolve than the ones recently placed. 

It's injected directly where the filler needs to be dissolved. Dr. Abdallah likes to massage the solution into the skin using pressures based on how far she wants the enzyme to spread. "When we are trying to dissolve everything, I massage it with more pressure to get the enzyme to spread to all the areas containing filler," she adds.

Post-injection, ice packs are typically given to the patient for a bit to reduce swelling and discomfort.

How much does it cost to get filler dissolved?

Dr. Chamata says that depending on the reason for needing the filler dissolved, such as filler complications, the provider may or may not charge you for the procedure. In some cases, Dr. Vasyukevich says the provider may charge a small fee.

When can you get injectables again after getting them dissolved?

If you want to go back and get the area re-filled, it's best to wait a moment before doing so. As the injection continues to work for two-three days after injection, Dr. Abdallah advises her patients to hold off on getting new injections for at least one or two weeks to allow enough time for any residual bruising or swelling to fade away. 

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