Filler Dissolving and Complication Clinic

Before and after image of filler dissolving procedure

What is Filler Dissolving?

Filler dissolving is a treatment process using an enzyme called Hyaluronidase. This enzyme naturally occurs but can be injected to dissolve a hyaluronic acid dermal filler.

At the Ezra Clinic, we ensure the use of the highest quality and evidence-based standards of care. Hyaluronidase can either be injected into the tissues or sometimes given topically; rubbed onto the skin, using preparations such as Topilase. In addition, there are also other possibilities for filler dissolving, such as laser therapy which can sometimes be used.

In these photos, this patient presented with grossly overfilled cheeks and tear troughs having created a convex look to the eyes and cheek. The filler was assessed using ultrasound and targeted filler dissolving applied to restore the natural contour of the face with a much more natural appearance.

Before and after of fillor dissolving treatment on the lips

Hyaluronidase

Hyaluronidase is an enzyme that naturally occurs in our skin. The enzyme is an approved prescription-only drug frequently administered to boost the absorption or dispersal of treatments injected underneath the skin. Additionally, it has an off license use in aesthetic medicine.

At the Ezra Clinic, our specialists administer the Hyaluronidase at a variety of concentrations, depending on the need and clinical details, in order to remove unwanted filler rapidly.

Hyaluronidase enhances the body’s natural process by dissolving the Hyaluronic acid bonds. The injected filler will almost immediately begin to soften and dissolve, but the whole process starts immediately and can take up to two weeks to complete.

What are the typical reasons for which filler needs to be dissolved?

As patients frequently visit cosmetic clinics pursuing filler treatment for a variety of aesthetic issues, complications can occur.

Fillers can cause a wide range of problems. Filler reversal is usually, but not always, effective in reversing these complications.

The most common complications in patients presenting to our clinic, requiring dissolving treatments include:

Swelling
Granulomas
Overfilling and facial distortion
Filler migration
Blue discolouration (Tyndall effect)
Contour irregularities
Infected filler
Serious complications such as vision loss or skin necrosis

These images demonstrate a patient attending with significant facial overfilling over many years with filler injections. This has given an unnatural appearance with a widened mid segment (cheeks). In addition, several other areas including the brow fat pads, lips, chin, and jawline, have all been over filled contributing to the unnatural appearance. This patient had a full MRI scan to evaluate the extent of the filler injections and subsequently had targeted dissolving injections provided safely and effectively.

Dissolving Dermal Filler Treatment Benefits

The treatment is quick and usually highly effective. By addressing the complications listed above, patients can expect the following benefits:

Remove migration of the filler
Reduce or eliminate unwanted treatment results: lumps, bumps and undo any poor placement after migration has occurred
Dissolve overfilled dermal fillers for better symmetry and alignment
Allow you to heal from any allergic reactions
Remove filler that resulted in a Vascular occlusion and/or impending necrosis (tissue death)
Allow you to heal from infections
Complete reversal with restoration of natural appearance.

What Results Can You Expect?

You can expect a few things, like the dermal filler being dissolved almost instantly. Results will generally be noticeable within the first 24 hours, but it can take up to two weeks to be fully apparent. If the outcome is not achieved, the treatment may need to be repeated.

While dissolving lip filler is the most common area to be treated, our highly skilled consultants can also manage other areas. Furthermore, we are experienced in managing uncommon and more severe complications such as abscesses and evasion loss.

We adopt a conservative approach to filler dissolving. When there is a very significant volume of filler requiring reversal, you may require 2-3 treatments in order to have the filler dissolved safely.

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What Does the Filler Dissolving Treatment Involve?

The injection takes just a few minutes and is provided on the day of consultation, if appropriate. We often provide a numbing cream to the area before the dissolver is applied. The injection is performed over a period of a few minutes.

We use several methods for dissolving fillers. During the consultation, our specialist will determine if the filler can be dissolved without a procedure. For example, this video demonstrates the “flooding therapy” approach with the doctor massaging into the area. It is typical demonstration of what patients should expect.

After establishing a plan during the consultation, it’s essential you prepare before your treatment. Prepare by not taking any blood thinning tablets such as ibuprofen or aspirin three days prior to the treatment unless prescribed. In addition, we advise you to avoid drinking alcohol 24 hours before.

ADDITIONAL TESTING

We often perform ultrasound tests of the area as part of the assessment. For more complex patients, we may also advise on MRI scanning. The MRI scanning is highly accurate and requires a 3D reconstruction to evaluate filler density and distribution, guiding the discussion for patients and being highly informative for patients.

In this video, you can see an example of the imaging technologies The Ezra Clinic uses to plan a successful filler dissolving treatment. We create highly specialised 3D reconstructions using MRI technology to map pre-existing filler. This MRI demonstrated extensive filler throughout the face.

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process of filler dissolving on a woman's eye area. It shows the before and after in three steps: assess counsel, disolve and rebuild.

These images above, illustrate issues arising from filler dissolving. The patient initially had swelling around the eyes due to filler injections from years ago. Dissolving the filler resulted in significant hollowing around the eyes. To address this, lower lids were reconstructed with lower blepharoplasty, and mid-face elevation and fat redistribution were performed. This case highlights that in a small subset of patients, appearance post-filler dissolving can be worse than before treatment. Hence, filler dissolving should be carried out by skilled experts capable of managing potential complications.

doctor checking a patient with filler on the lips

During the Procedure

The doctor will apply the numbing cream 15 to 20 minutes before the injection. When the area is numb, the dissolving enzyme is injected to break down the filler, and the site will then be massaged to ensure even distribution of the product.

The process of injecting hyaluronidase is typically a few minutes, but in total, the entire procedure, including preparation, may take up to 30 minutes. After the treatment, the doctor will apply aftercare cream and discuss how best to look after the treated area.

After the procedure

We advise you to avoid:

Touching the treated areas for 6 hours to prevent infection
Makeup for 6 to 8 hours
Intensive exercise for the next 48 hours
Any extreme temperatures such as hot and cold. Avoid being sun exposure, steam rooms, sunbeds or saunas for 7 days.
Avoid blood thinning medication. This includes aspirin for 48 hours unless your doctor has prescribed it.

Woman with complications from a filler in the before image and with healed skin after filler dissolving

As experts in oculoplastics, The Ezra Clinic is best placed to manage even the rarest and most severe complications. This before image demonstrates large abscesses caused by filler injections. The abscesses were not treated or recognised by the original practitioner. The patient required urgent surgical debridement and dissolving of the filler, with excellent results 9 months later.

Depending on the hyaluronic acid filler type, you can expect it to begin breaking down and disappear in minutes. However, the treatment results will usually show after 24 hours once the swelling has gone down but the whole process can take up to two weeks to start working.

As The Ezra Clinic prioritises your safety, the procedure goes as planned. It is also possible to experience the side effects mentioned above. You will be fully informed of the risks and benefits to make an informed decision regarding whether this is the right treatment for you.

More and more evidence is demonstrating that fillers last for much longer in tissues than previously thought. At the Ezra Clinic, we have had patients with filler-related problems presenting up to 20 years after their last filler injection. Depending on the type of filler you have, the gels may remain in the body for many years. We aim to inject the appropriate enzyme dose to dissolve the unwanted filler but not minimise the effects on natural hyaluronic acid. This means multiple treatments may be required to remove the unwanted filler thoroughly.

After the treatment, you may experience redness, swelling, pain, itching, bruising and tenderness at the injection site. Usually, the bruises are mild to moderate and go away a few days after the injection. Paracetamol, ice, and arnica cream can be used to manage the side effects.

Like any other procedure, there are always some risks that can occur.

The Ezra Clinic has published the largest dataset of filler dissolving patients and assessed the outcomes. We have found that the vast majority of patients are happy with the dissolving treatment. However, approximately 15-20% of patients will be unhappy with the outcome, feeling that their appearance is worse than it had been prior to any filler being injected. We describe this phenomenon as the “Post-Hyaluronidase Syndrome”.

These problems are usually related to volume loss but can also relate to volume deflation and new lines being formed. An integral part of the consultation is to discuss the data and evidence to patients and together to weigh up the pros and cons of filler dissolving. These can sometimes be difficult decisions.

Also, a rare risk of an allergic reaction to Hyaluronidase can occur. This includes anaphylaxis, which requires immediate medical attention.

Signs of an allergic reaction include:

Prolonged redness
Facial or mouth swelling
Itching
Hardness
Bumps in the skin

Such symptoms may appear at some or all injection points.

Note: You are more likely to react to hyaluronidase if allergic to bee and wasp stings.

Daniel Ezra's facilities

Consultation room at Daniel Ezra

The hyaluronidase enzyme only dissolves hyaluronic acid fillers such as Juvéderm, Restylane, Teoxane and Belotero. If your filler is non-hyaluronic acid, this treatment will not work and can only be surgically removed. Book a consultation with us to determine if your filler is compatible with hyaluronidase.

Our aim at The Ezra Clinic is to ensure your desired goals and care are achieved with the highest standards. Central to this aim is to inform patients of the medical evidence regarding risks and success. We discuss and review the desired outcome during your consultation and the day of the treatment to ensure the plan is in order or if you have changes in mind. Many patients are understandably unhappy with their appearance after the filler is dissolved. For most of these patients, we will plan a ‘rebuilding’ process, often also involving surgery to deal with the residual aesthetic issues that you may experience. The Experts at the Ezra Clinic have extensive expertise in this process, which often involves combining surgical and non-surgical approaches where possible.

Some fillers require more than one session to dissolve. For example, large molecule filler is mainly used for cheek, chin, or jaw lines. At The Ezra Clinic, we aim to inject the appropriate amount of enzyme required to break down the unwanted filler while leaving the hyaluronic acid intact. This means more treatments could be necessary to remove the undesired filler completely.

Besides the procedure being quick and permanent, it is typically not painful. Our specialist will provide numbing cream or injections. However, in some patients where larger volumes of dissolver are needed, the injection can be painful for a very short time (a few seconds).