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Removing Facial Fillers with Hyaluronidase
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Dermal fillers continue to increase in popularity for many reasons, with their great effectiveness, nonsurgical convenience and minimal downtime. Injections of facial fillers are performed by many types of cosmetic specialists, including dermatologists, plastic surgeons, ophthalmologists, and facial plastic surgeons. Sometimes, however, a patient wants the facial filler to be reversed or removed, or adjusted post-treatment. In these cases, hyaluronidase injections are used to reduce or remove hyaluronic acid fillers. Treatment with hyaluronidase speeds the body’s natural breakdown of these types of dermal fillers.

The most common reason patients want to reverse a dermal filler treatment is for an undesired cosmetic result. “Too much”, “too different”, “not what I expected”, “looks worse” are some of the reasons filler patients want reversal. Other reasons may include imperfect visual results such as asymmetry, lumps, bumps, granulomas, or nodules. Some patients also may develop a bluish appearance to the skin (i.e. the Tyndall effect) from some fillers placed too superficially. In addition, prolonged tissue swelling or allergic reactions from dermal filler treatment can be another reason to consider hyaluronidase.

What are facial fillers made of?

Facial fillers such as Juvederm, Restylane, and Belotero primarily consist of a material called hyaluronic acid (HA). HA is a natural component of human skin. HA fillers are a clear gel that softens facial wrinkles, augments lips, and augments cheeks. HA fillers vary in their consistency and thickness and are tailored for certain areas of the face. For example, some Juvederm products are very popular for lip injections.

Other fillers such as collagen injections, including Radiesse, and Sculptra are made of other materials that cannot be reversed. Methods other than hyaluronidase are required to manage undesired results occurring from these non-HA fillers.

What is hyaluronidase?

Hyaluronidase is a natural occurring enzyme in our tissue that interacts with our own hyaluronic acid. In fact, hyaluronidase injections are considered very safe and have been used for years for non-cosmetic purposes in medicine before being used in cosmetic surgery to reverse the effects of HA fillers. Hyaluronidase injections are used to help speed the delivery and/or dispersion of other drugs. For instance, in ophthalmic surgery, surgeons use hyaluronidase mixed with local anesthesia to help the anesthesia disperse more readily.

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How is the hyaluronidase treatment performed?

The technique of hyaluronidase treatment takes very little time. A small needle is placed in the area of the previous HA filler injection, whether it’s the cheeks, lips, nose, or eye area. Most patients don’t require pretreatment numbing prior to hyaluronidase treatment. Any discomfort or bruising is typically mild and short-term.

Results from hyaluronidase treatment will be noticeable within minutes after injection and continues to work with time. Repeat injections of hyaluronidase may be necessary to help dissolve all the filler as necessary. Injecting hyaluronidase is not known to permanently dissolve any naturally occurring HA in your own tissue. In addition, hyaluronidase may be injected at anytime after HA filler treatment, even many months after.

Hyaluronidase primarily works on dissolving HA from aesthetic treatments. As previously noted, it does not directly reduce or remove scar tissue, swelling, and non-HA fillers (ex. collagen, Radiesse, Sculptra).

Lastly, keep in mind that hyaluronidase injection is not an exact science. Some or all of the HA filler may be removed with a single hyaluronidase treatment. For those who just want “a little excess HA filler removed” might have all of it dissolved by a very small injection of hyaluronidase. Patients who have had thick HA fillers injection (eg. Juvederm Voluma) may require repeated hyaluronidase treatments to have all the filler removed.

What is the cost of filler removal with hyaluronidase?

The price of hyaluronidase will vary based on many factors, such as the specific brand, number of treatments required, etc. Generally speaking, however, hyaluronidase treatments are usually less expensive than facial fillers per injection.

Patients don’t have to live with the results of HA dermal fillers if they are not happy with the results. Lips that are too large, eyes that are too puffy, or cheeks that don’t match expectations after dermal filler treatment can all be potentially treated with hyaluronidase.

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