Filler Dissolving with Ultrasound Guidance and Hyaluronidase
Filler has recently become less popular with more and more people starting to realize the long term risks. Filler lasts much longer than 1-2 years, gets stiffer, and naturally degrades unevenly resulting in a lumpy appearance. Filler builds up over time and can migrate from its original intended location. Because filler attracts water, an over-filled, puffy appearance may occur. Consequently, many people are now interested in having their filler dissolved and opting for other treatment options instead.
What types of filler can be dissolved?
Hyaluronic acid (HA) filler can be dissolved with Hyaluronidase. Whereas other types of filler (Bellafil - silicone) and Sculptra or Radiesse (biostimulators) cannot be dissolved with Hyaluronidase. Some types of filler such as Juvederm is more difficult to dissolve due to it’s extensive chemical crosslinking.
A study published in Jan 2023 in the Journal Molecule describes how different brands of Hyaluronidase such as Hylenex is superior to Hyalase in dissolving filler. Luckily, Hylenex is readily available in the United States. Read the full article: article link
How many sessions of Filler Dissolving will I need?
People are most often surprised by how difficult it is to dissolve filler and by the number of sessions it requires. For 1 syringe of filler, it is not uncommon to require 2-4 sessions of filler dissolving and several vials of Hyaluronidase to achieve the desired outcome. It’s much easier to dissolve filler when there is a large collection in one spot. However, most of the time filler is dispersed in tiny amounts diffusely. For those who have had many syringes of filler over many years, it could require 10 - 15+ sessions of filler dissolving, and yet not all the filler will be entirely dissolved.
How does Ultrasound help to dissolve filler?
Ultrasound increases accuracy and efficiency by allowing direct visualization of filler location and depth as well as proper cannula or needle placement. An ultrasound with doppler capability can help distinguish the difference between vessels and pockets of filler as both will appear dark. Silicone filler such as Bellafil will look different than HA filler. Ultrasound can also help to reduce the risk of bruising or hematoma formation by allowing visualization of the vessels to avoid.
It’s important to remain up to date on the most current clinical data for best outcomes with a commitment to safety. It’s also important to have the best equipment with proper features to allow for visualization of superficial anatomical landmarks. Dr. Kaplan at Rejuve Medspa in Newcastle, WA has over 25 years experience using ultrasound and has expertise in dissolving filler.
What are the common reasons to dissolve Filler?
Changing Trends: Sometimes we change our minds about following trends such as big lips, big cheeks, or pointy chins. Nothing wrong with wanting to revert back to your original or more natural appearance.
Filler Migration: Over time, filler can migrate from its intended location. Lip filler injected into the vermilion border can migrate outside of the lips. While lip filler injected too close to the wet/dry border can cause a lumpy or uneven smile along the inside border of the lips. Gravity and muscle contractions can eventually cause mid cheek filler to migrate downwards, causing an accentuated fullness to the lower cheeks and worsening the appearance of the nasolabial folds. Chin filler can migrate below the jawline causing an unusual contour.
Unnatural appearance: We often lose sight of how we look. Slowly adding more filler over the years can eventually lead to an over-filled look.
Lumps and bumps: Lip filler injected too superficially can cause a bumpy appearance. Under eye filler can frequently cause a lumpy appearance.
Bad outcome: Sometimes, filler can lead to delayed nodules or even infections (recurrent abscesses) in which case, the filler should be removed entirely.
Vascular occlusion: Filler inadvertently injected into an artery can cut off the blood supply to the surrounding normal tissue, leading to necrosis. If this happens, the filler should immediately be dissolved. In rare cases, even blindness or stroke symptoms can occur.
Do I need to remove all of my filler or can I keep some of it?
Not everyone wants all of their filler dissolved. Sometimes removing a small amount of filler can help achieve the desired outcome. If there is a nodule or complication related to old filler, it’s probably best to dissolve everything and start over with a clean slate.
How soon after getting filler dissolving will I know the results?
Filler dissolving usually works fairly quickly. However, on the day of dissolving you can expect to have swelling from the injection and fluid associated with injection of Hyaluronidase. Typically it can take 1-3 days for the swelling from the injection to reduce and for the effects of Hyaluronidase to become apparent.
How much does filler dissolving cost?
Dissolving filler is expensive. There are multiple factors that contribute to the cost. Primarily, Hylenex is an expensive product. Other supplies such as lidocaine solution, sterilizing products and other medical supplies are additional expenses. Dissolving filler with Ultrasound guidance takes more time and adds more cost than blindly dissolving filler because it requires more precision, more clinical expertise, and specialized equipment. On the other hand, dissolving filler without ultrasound guidance will likely result in missed areas and/or uneven results.
What are the potential side effects of Hyaluronidase?
There is a less than 1% chance of allergic reaction which is more likely if you have a bee sting allergy. Other potential complications include risk for local swelling, bruising, discomfort, itching. Injecting lidocaine can help with discomfort. Using ultrasound and/or Accuvein can help identify vessels to avoid, and will reduce the risk for bruising.
