Dermal Filler Dissolving

Treating complications of Facial Injections

Topless Woman

Dr Chiké Emeagi at Hampstead Aesthetics is an expert in treating complications of dermal filler facial injections.

 

At our clinic Hyaluronic acid dermal fillers such as Juvederm, Restylane, Teosyal, Belotero and Stylage can be dissolved using an enzyme called Hyaluronidase. The enzyme is naturally occurring, but can be injected at a higher concentration to dissolve dermal filler at a precise location.

 

The solution works by breaking up the bonds that hold the Hyaluronic acid (HA)  molecules together. The enzyme has an immediate effect and has a half-life of two minutes with duration of action of 24-48 hours.

REASONS A DERMAL FILLER MAY NEED DISSOLVING:

  • Dermal Filler migration resulting in swelling- 

Ultimately the filler will move to the path of least resistance to find a comfortable place to sit. Some patient’s  tissues have more “pockets” or laxity and therefore less support in keeping a filler in place. Additionally filler is quite soft and moveable for the first 48 hours post treatment, so there can be some compression of filler around areas of higher muscular contraction or if a patient swells greatly post treatment, this can also cause some compression or movement of product. 

 

  • Asymmetry and product overfilling, lumps and unevenness of dermal filler product

Areas where we see lumps and bumps the most unfortunately is in the trough and lips. The tear trough because the skin is so thin and unforgiving here and anatomically it is quite unique and more complex. The lips because of the high muscular function, the area, and tissue differences seem from patient to patient. Other areas of the face such as the chin, cheek bone, or nose, we are almost trying to create small “lump or bumps” referred to as boluses, to help lift the tissue and create structure.

 

Here we try to ensure they are smooth and consistent , however we don’t want to over massage these areas, as we would lose the lifting or volumizing effect that was initially intended with the dermal filler injection. 

WHAT IS THE PROCESS OF FILLER DISSOLVING?

1. Full Consultation and assessment of the proposed region to be dissolved. Full discussion will be had detailing the risks of the procedure and benefits to be achieved. The after treatment plan will be discussed.

 

2. Patch test must be done as there is a small chance of allergic reaction with the Hyaluronidase enzyme.  A patch test is performed by injecting a small amount of the enzyme subdermally in the forearm. Our protocol is to wait 30 minutes at the clinic to see the result of the patch test.

3. Topical analgesia--Numbing cream can be applied on the areas that need dissolving 15-20 minutes before the injection.

 

4. Hyaluronidase enzyme is injected at the intended site

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Before & After Results

Note. Tear trough previously overfilled with dermal filler.

Hyauronidase  Enzyme via cannula used to dissolve Filler.

Pictures immediately after the procedure. Immediate results seen.

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FAQs

Find the answers to your questions about dermal filler dissolving treatments with Hampstead Aesthetics.

If you would like to find out more, simply contact us for further information.

What can I expect after the Hyaluronidase injection?


The treated areas will likely swell for up for 2-3 hours. The degree of swelling is often dependent on the amount of Hyaluronidase used. The result of the dissolving is immediate although it will still be working 3-7 days but to a lesser extent.




Will the filler be dissolved completely in one session?


Depending on the density of the Hyaluronic acid filler, some may need more than one session to dissolve. We offer a review at 2 weeks to assess if more dissolving is required.




Is the Hyaluronidase injection painful?


At the clinic we tend to use a Cannula technique, and use topical numbing agents to reduce the entry point pain. Our experience is that these procedures cause very minimal discomfort.




Can the doctor correct the dissolving areas after the dissolving?


If a patient is looking for some aesthetic adjustments, and wants to go ahead with dissolving, they must understand that they might also need to replace areas that may have dissolved unevenly with dermal filler. If the treatment was performed at another clinic, then this will be at the patients expense




Can Hyaluronidase enzyme dissolve my own hyaluronic acid?


It is normal for our own natural hyaluronic acid to be temporarily broken down in the adjacent area by the enzyme but this quickly regenerates with our own bodies natural HA product within a few weeks. Ultimately collagen remodelling happens 2-3 months post procedure. Bear in mind- our own hyaluronic acid naturally last only 3 days and our skin will reproduce the new hyaluronic acid to the same amount that has been dissolved in a couple of days. Just like overfilling can happen with filler, so can over dissolving. this is why we tend to go slowly and in stages, choosing the right concentration and unit to inject, however at times a patient's response is beyond our control. 2 weeks is encouraged to add more dermal filler in a previously dissolved area to ensure all swelling and injury has resolved and the patient is back at baseline.




Are there any side effects of Hyaluronidase injection?


Just like there are risks or adverse events associated with injecting dermal filler, hyaluronidase itself is not risk free as it can cause temporary discomfort of injection, redness, swelling, bruising and very rarely allergy.
Often if it is a patients first exposure to hyaluronidase, we will do a patch test on the arm to ensure the patient is not allergic to the product before proceeding with dissolving filler in facial tissues. A history of allergic reaction to wasp or bee stings represents an increased risk of allergic reaction to hyaluronidase and should be considered as a relative contraindication, as the venom of stinging insects might contain hyaluronidase and this mechanism might be the source of sensitization in affected individuals. Unless there is a past medical history of allergic reaction or anaphylaxis to hyaluronidase or insect bites, previous history of allergy seems unrelated for the administration of hyaluronidase and it can be safely performed. The side effects include - Allergic reaction. Therefore, patch test 30 minutes prior the treatment is essential. - Temporary mild swelling can be observed. - Temporary skin laxity from fast deflated areas in the case of dissolving large amount of filler.