Risks and rewards: What to know about dissolving filler

It's one of the most popular minimally invasive treatments that is used in a variety of ways to rejuvenate the face. Hyaluronic acid injectable fillers like Juvéderm Ultra®, Juvéderm Ultra Plus® and Restylane® can plump your pout, smooth fine lines and wrinkles and add volume and fullness to your face. These injectables tend to be soft and gel-like and can enhance the shape and contours of the face and lips, giving people a more youthful appearance.

Some people want softer, fuller lips, while others want to address the natural volume loss that can occur with aging. However, the results aren't always the ones you expect. Can you change your mind if want your previous face back?

The choice to get fillers is personal, just like the choice to dissolve fillers. Going into cosmetic procedures, you need to know what to expect and what your options are if you discover you don't recognize the person looking back at you in the mirror.

How do you dissolve filler?

To dissolve or not to dissolve? It is a bit of a loaded question. People choose to dissolve filler for numerous reasons – personal and aesthetic. However, before you blast back, you should understand the risks and rewards.

In the United States, hyaluronic acid, found in products like Juvéderm and Restylane, is the most common type of injectable filler. It is a naturally occurring compound found in nearly all living things, including us. Hyaluronic acid filler can add volume and fullness to the lips and cheeks and improve the appearance of fine lines and wrinkles, such as smile lines and crow's feet.

Many people love how filler gives them a more youthful and bouncy appearance. However, the look is not for everyone, and some people don't realize they don't like the effect until after the filler has been injected into their faces.

"A patient would get filler dissolved for a number of reasons," said Anureet Bajaj, MD. "These may include not liking the appearance of filler, the development of a nodule or irregularity, filler migration or vascular injury."

Sara Dickie, MD, doesn't dissolve much filler in her practice, but she said having an open discussion about the procedure and how it works with patients is important. She noted the main reasons people consider having filler dissolved include not liking the results, the filler migrating to a place that looks unusual or they are having an inflammatory or allergic reaction to the filler.

Dissolving filler involves using hyaluronidase, an enzyme that breaks down the body's hyaluronic acid.

"Our bodies have a natural enzyme, hyaluronidase, that breaks down our body's own hyaluronic acid, and therefore, any HA used as a filler will naturally be degraded by this same enzyme," said Dr. Dickie. "That usually takes 8 to 18 months, depending on the type of filler. We have the benefit of having hyaluronidase available off the shelf as a medication. This product, which is highly concentrated, can be injected into the area the filler was placed, and typically, the filler will dissolve almost immediately and be resorbed by the body."

What are the risks of having filler dissolved?

Like with any other procedure, there can be risks involved with dissolving fillers.

"Just like the placement of filler, the injection of hyaluronidase involves a needle injection," said Dr. Dickie. "The same risks of getting filler exist with dissolving filler, such as pain, bruising, bleeding and swelling."

Dr. Bajaj also said that patients can experience side effects like allergic reactions, redness at the injection site, swelling and bruising.

"Many also do find the injection to be painful or uncomfortable," said Dr. Bajaj.

Aside from some of the more obvious risks and side effects, Dr. Dickie pointed out that there are other things patients need to consider.

"Because hyaluronidase is a pure liquid and not a gel, there is no risk of occlusion (blocking a blood vessel)," said Dr. Dickie. "In fact, hyaluronidase is typically used in cases of suspected or known vascular occlusion."

That's the good news. Yet, not everything is straightforward.

"If a patient wants to dissolve just a little of the filler, that is often very hard because the hyaluronidase spreads into the tissues where it is injected and can dissolve any filler that is there," said Dr. Dickie. "So, it is hard to be very specific with dissolving. I tell patients that they should consider dissolving filler as all or nothing."

There are benefits to getting back to baseline

If you find that filler just isn't your thing, there are benefits to getting it dissolved and getting back to baseline.

"If you are having filler dissolved electively, the main advantage is that we can return to what you looked like before having filler – like a blank canvas," said Dr. Bajaj.

Dr. Dickie explained that patients who want to dissolve their filler can typically expect to see results immediately. However, the final result and complete removal of filler can take up to several days.

"I typically recommend patients massage the area that has been injected every day for five days," said Dr. Dickie. "Patients typically have swelling after having filler dissolved, so they can ice the area the first one to two days to help reduce that."

Dr. Bajaj also cautioned against taking certain over-the-counter pain relievers.

"Patients may experience bruising and swelling and should ice and take it easy for 24 hours," said Dr. Baja. "They should also avoid aspirin-containing products seven days prior to the injection to help minimize the risks of bleeding and bruising."

Adding and dissolving filler is a personal choice, but there are proactive steps you can take to reduce the chances that you'll need additional injections to achieve the look you want. If you are interested in filler, start by doing your homework and having an honest conversation about the results you expect to achieve with a board-certified plastic surgeon who is an ASPS member.

You reduce your chances of experiencing disappointment and significant medical complications by putting your face in the hands of an experienced plastic surgeon. However, if you do experience side effects such as an inflammatory response or allergic reaction, seek medical help immediately.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.