Everything You Need to Know, According to Experts

Some beauty treatments come with regret, and fillers are no exception. Whether filler fatigue, migrating product, or a different aesthetic ideal has you wanting to undo the effects of your once beloved filler, the good news is you can do it. Even celebrities like Courteney Cox and Olivia Culpo have fessed up to it. Dissolving (hyaluronic acid) filler is gaining popularity for a handful of reasons, and if you are ready to get rid of it once and for all, or start over fresh, dissolving it is the way to go. Ahead, we tapped three experts, dermatologists Dr. Kami Parsa, MD, and Dr. Morgan Rabach, MD, and nurse practitioner Jackie Spagnuolo for the 411 on what to expect when dissolving filler.

What Are Fillers?

Simply put, dermal fillers are injectable substances that help to volumize, sculpt, and enhance facial contours and smooth out wrinkles. “Fillers can correct shadows under the eyes, asymmetries in the face, restore volume related to aging, like cheek and temple hollows and nasolabial folds, help define the jawline, plump lips, and fill in superficial wrinkles,” Dr. Rabach says.

A few different types of fillers exist. The main filling agents used in injectable fillers include hyaluronic acid (Restylane and Juvederm fillers), a synthetic version of naturally occurring hyaluronic acid found in the skin, cartilage, eyes, and joints; calcium hydroxylapatite (Radiesse), which gives more of a long-lasting contouring effect; collagen-stimulating Poly-L-lactic acid (Sculptra) for added structure; and polymethyl methacrylate (PMMA), a permanent filler (Bellafill) to smooth wrinkles around the mouth. Dr. Parsa says hyaluronic acid fillers are the most commonly used dermal fillers.  

Of all the types of fillers offered, only hyaluronic acid fillers are dissolvable. That’s because, as Spagnuolo explains, hyaluronic acid fillers contain substances that break down from an injectable enzyme known as hyaluronidase. “All other fillers are not susceptible to enzymatic breakdown and instead require time to be naturally absorbed by the body,” she shares. Although non-hyaluronic acid fillers have the potential to cause the same problems as hyaluronic acid ones, including excessive swelling, lumps, and bumps, Dr. Parsa cautions to never inject them into areas where complications can occur, like around the eyes and tear troughs.

Reasons to Get Filler Dissolved

A multitude of reasons can have you wanting to undo the effects of hyaluronic acid filler either in the days following your injections or months later. Here are the most common reasons dermatologists use hyaluronidase to undo unwanted effects.

Migration

Hyaluronic acid fillers can migrate more in some than others because of natural facial anatomy, which largely influences precisely where and how the filler will settle. Dr. Rabach explains that if filler is placed incorrectly, at the incorrect depth, or too much is injected, it migrates to a neighboring area because it has nowhere else to go. When filler migrates, the result is an uneven or unnatural appearance with lumps, bumps, or asymmetries.

Asymmetry

When filler goes wrong, one specific feature can appear out of balance. “When something is too big, like the lips, for example, you may desire a more natural, subtle enhancement,” Dr. Rabach adds. Often, filler-related asymmetry is caused by overfilling an area or migrating product.

Lumps and Bumps

One unfortunate side effect of filler is lumps and bumps that can develop weeks after the initial injections. Lumps and bumps can easily occur in areas where the skin is thinner, like the lips. Post-injection massage is critical in helping filler lay down properly, but it needs to be done right so as not to shift the product out of place.

Overfilling

Injecting too much filler into the face can lead to an unnatural, overfilled, and even heavy look. Overfilling the lips, lower faces, and cheeks distorts these features and, therefore, the face overall, making it appear swollen and puffy, which can cause uneven results, Spagnuolo says. Plus, hyaluronic acid fillers can block lymphatics, which Dr. Parsa says can cause swelling and expansion of natural tissue, leading to the condition commonly referred to as an ‘overfilled face.’

Negative Reactions

Unfortunately, fillers can have adverse effects, which Dr. Parsa says can lead to inflammatory reactions and cause a blockage of the lymphatics that can cause swelling. For some, swelling is long-lasting and affects the cheek area below the eye socket bone. “When malar edema occurs, it presents itself as puffy pouches close to the cheeks because the lymphatic system, which is like plumbing in a house, becomes blocked and fluid can’t flow properly, leading to swelling,” he explains. Other signs of filler gone wrong include asymmetry, nodules, tissue loss due to injecting filler into a blood vessel, and the Tyndall effect, which is when the skin appears with blue discoloration due to superficially placing hyaluronic acid filler. Spagnuolo says that if an allergic reaction occurs, it is best to dissolve the filler immediately.

Changes in Aesthetic Goals

Nothing lasts forever, and what looked good at one time may not be the aesthetic norm anymore, causing people to want to undo the effects of their fillers. The once overfilled, bigger-is-better look is being traded in for a more natural appearance more and more. “People often seek fuller lips and cheeks, but too much filler can create an unnatural or exaggerated appearance,” Spagnuolo adds.

What to Expect When Getting Filler Dissolved

Dissolving unwanted hyaluronic acid fillers is similar to injecting them, although Dr. Rabach says to expect a bit of stinging. During the treatment, which takes about 10 minutes, numbing cream is first applied to the treatment area to minimize any discomfort. Your dermatologist or injector may also use ultrasound to help localize the filler. Next, a small amount of hyaluronidase, the antidote to unwanted fillers, is injected directly into the area where the filler is. “The enzyme breaks down the hyaluronic acid, which the body then absorbs naturally,” Spagnuolo says. Post-dissolving, discomfort, swelling, bruising, or redness may occur. Even though hyaluronidase begins working immediately, the dissolving effects tend to peak at around the 48-hour mark, and the tissue will settle over the next three to ten days.

Dr. Parsa recommends only dissolving some of the filler, not all of it, to prevent a deflated look. “Typically, I wait two to four weeks before dissolving any remaining filler that needs treatment,” he says. “Since hyaluronidase targets the bonds that hold the hyaluronic acid molecules together in the filler, once these bonds are broken, the body can more easily absorb hyaluronic acid fragments.” Larger lumps, bumps, nodules, older filler, and areas where the fillers have spread out drastically may take multiple sessions to dissolve.

If the skin emerges a bit loose after dissolving filler, Dr. Parsa likes to perform a tightening procedure such as a CO2 laser or fractionated radiofrequency (Morpheus8). “Some patients may require surgery if too much filler was previously injected.”

The Cost

The cost to dissolve hyaluronic acid filler can vary from injector to injector, but typically, it ranges from $400 to $1,500 per session. The amount of filler that needs to be dissolved, how much hyaluronidase is used, the number of sessions you will need to get rid of it, and your doctor’s expertise all factor into the price.

Potential Side Effects and Aftercare

Immediately after dissolving the filler, Spagnuolo suggests applying ice packs to reduce swelling and avoiding strenuous exercise for 24 to 48 hours. “It’s also a good idea to keep the area clean and avoid wearing makeup for at least 24 hours.” Swelling, bruising, and minimal, temporary lumps and bumps at the injection site are normal, but contact your dermatologist immediately if an allergic reaction occurs. When dissolving filler, hyaluronidase has the potential to break down some of the naturally occurring hyaluronic acid, but it is minimal at most.

The Final Takeaway

Dissolving filler is the easiest way to undo the unwanted effects of hyaluronic acid gone awry, but there’s plenty to know about the procedure. Although dissolving filler can help smooth away lumps, bumps, and an overfilled, unnatural look, not every patient returns entirely to baseline, and some residual volume may exist. But just because you choose to dissolve your filler doesn’t mean you can’t get filler again. Just make sure to find an injector who is well qualified and whose aesthetic ideal matches yours so that you are happy with the results.