Does Dissolving Dermal Fillers Dissolve My Natural Hyaluronic Acid?
This is one of the most frequently asked questions when considering filler dissolution. Fortunately, the answer is largely reassuring and grounded in science.
How Hyaluronidase Works
Hyaluronidase is the enzyme used to break down hyaluronic acid (HA) fillers. Whilst it does affect both the injected filler and your body's natural HA temporarily, the impact on your endogenous HA is minimal and short-lived. Understanding this mechanism is key to alleviating concerns about long-term tissue damage.
Hyaluronic Acid in Human Tissue
The human body contains approximately 15 grammes of hyaluronic acid in total, distributed throughout various tissues:
Skin: Approximately 50% of the body's total HA resides in the skin, where it maintains hydration, plumpness, and structural integrity
Eyes: The vitreous humour contains significant HA concentrations, contributing to its gel-like consistency
Joints: Synovial fluid relies on HA for lubrication and shock absorption
Connective tissues: HA is present throughout the extracellular matrix, providing tissue support and facilitating cell migration
The amount of HA in dermal fillers is relatively modest compared to your body's total HA content — typically 0.5–2ml of product containing 20–25mg of HA per millilitre. This contextualises why the temporary local depletion caused by hyaluronidase doesn't significantly impact overall tissue health.
How Much HA is in the Face?
The face contains approximately 7–8 grammes of hyaluronic acid, representing roughly half of the body's total HA content. This is distributed throughout:
Dermis: The deeper layers of facial skin contain the majority of HA, providing structural support and hydration
Epidermis: The outer skin layer contains smaller amounts but plays a crucial role in surface hydration and barrier function
Subcutaneous tissue: HA is present in the fat pads and connective tissue that give the face its three-dimensional contours
This natural facial HA is constantly being renewed, with approximately one-third being synthesised and degraded daily through normal metabolic processes. This turnover is a sign of healthy, dynamic tissue maintenance.
What Happens During and After Dissolution
Immediate Effects
Hyaluronidase breaks down both filler and some natural HA in the treatment area. This is why some people notice temporary flatness or slight hollowing immediately after dissolution — it's a localised, transient effect, not permanent tissue loss.
The Healing Timeline
24–48 hours: Most hyaluronidase activity occurs within the first two days. The enzyme is rapidly metabolised and cleared from the tissue
2–4 weeks: Your body begins actively regenerating natural HA. Fibroblasts in the skin ramp up production of new hyaluronic acid as part of normal tissue repair and maintenance
1–3 months: HA levels typically return to baseline. Given that your body naturally produces and breaks down about one-third of its total HA every day, regeneration is a constant, ongoing biological process
Will You Look Worse Than Before You Had Fillers?
In most cases, no. Here's why this fear is largely unfounded:
Natural regeneration: Your body continuously produces new HA through fibroblast activity, so any temporary depletion is restored through normal biological processes
No permanent cellular damage: Hyaluronidase doesn't harm or destroy the fibroblasts that produce HA, so your regenerative capacity remains fully intact
Localised effect: The enzyme works primarily in the injection site, not systemically throughout your entire body or even your entire face
Return to baseline: Most people return to their pre-filler appearance, not a worse state. You're revealing your natural face, not a damaged version of it
Temporary Considerations
However, there are some short-term factors to bear in mind:
Immediately post-dissolution, the treated area may appear slightly deflated due to both filler removal and temporary HA depletion
If you've had fillers for many years, you may have become accustomed to the enhanced volume, making your natural features seem less full by comparison (though objectively unchanged from your original baseline)
Any swelling from the original filler that was masking age-related volume loss or structural changes will now be revealed
Oedema and inflammation from the dissolution procedure itself can temporarily alter your appearance before settling
The Ageing Process Doesn't Stop with Fillers
This is perhaps the most crucial point that's often overlooked: whilst you have fillers, the natural ageing process continues underneath. This is not something people are commonly warned about, and it can lead to significant distress when fillers are dissolved.
What's Actually Happening Beneath the Filler
When someone has had fillers for several years and then dissolves them, they may be shocked by their appearance — but this is typically due to biological ageing, not tissue damage from hyaluronidase. Here's what's been occurring all along:
Bone resorption: Facial bones naturally recede with age, particularly around the eyes, cheeks, and jawline. This process continues whether you have fillers or not, creating a less robust skeletal foundation
Fat pad descent and atrophy: Facial fat pads shift downward and diminish in volume over time, creating hollows and sagging that fillers may have been masking entirely
Collagen and elastin loss: Your skin loses approximately 1% of its collagen per year after age 20, leading to thinner, less supported, and less resilient skin
Natural HA decline: Even without dissolving fillers, your body produces progressively less HA as you age — by age 50, you may have half the HA you had at 20
Muscle changes: Facial muscles weaken, thin, and change position with age, affecting overall facial structure and contours
Skin laxity: Loss of elasticity means the skin doesn't "snap back" as it once did, leading to sagging and jowling
The Timeline Matters
Consider this scenario: if you had fillers placed at age 30 and dissolve them at age 40, you're comparing your current 40-year-old face (without fillers) to your 30-year-old face (before fillers). That's a decade of biological ageing that occurred whilst the fillers were providing volume and masking these progressive changes.
During those ten years:
Your bone structure has changed
Your fat distribution has shifted
Your skin has thinned and lost elasticity
Your collagen and HA production has declined
The fillers were essentially "freezing" your appearance at a certain point, whilst your underlying facial architecture continued to age. When you remove the fillers, you're not seeing damage — you're seeing reality.
The Perception Problem
Because the fillers were maintaining a more youthful appearance, dissolving them reveals the accumulated effects of ageing all at once. This can feel dramatic and alarming, leading some people to mistakenly believe that the hyaluronidase "dissolved their face" or caused permanent tissue damage.
In reality, they're simply seeing what their face looks like at their current age without enhancement — something they would have witnessed gradually if they'd never had fillers at all. The shock comes from the sudden revelation, not from actual harm.
It's Ageing, Not Damage
This distinction is critical: the hyaluronidase removed the filler and temporarily affected local HA (which regenerates within weeks), but it did not cause the bone loss, fat atrophy, collagen degradation, or skin laxity that developed naturally over the years you had fillers.
Your baseline has changed because you've aged, not because the dissolution procedure harmed your tissues. The enzyme simply revealed what was already there — your true, current face.
Supporting Natural HA Production During Healing
Whilst your body will naturally regenerate HA, you can support this process:
Hydration: Drink plenty of water to support HA synthesis and overall skin health
Nutrition: Ensure adequate intake of vitamin C, zinc, and magnesium, which are cofactors in collagen and HA production
Skincare: Use topical HA serums to provide surface hydration whilst your skin regenerates its deeper HA layers. Look for different molecular weights for multi-level hydration
Avoid additional trauma: Give the treated area time to heal before considering any further aesthetic procedures
Sun protection: UV damage impairs HA production and accelerates collagen breakdown, so use broad-spectrum SPF 30+ diligently
Gentle skincare: Avoid harsh exfoliants or aggressive treatments immediately post-dissolution
Consider supplements: Some evidence suggests that oral HA supplements may support skin hydration, though topical application and natural production remain primary
Conclusion: Understanding the Real Picture
The fear that dissolving fillers will leave you looking worse than before is understandable but largely unfounded when you understand the science. Yes, hyaluronidase temporarily affects natural HA levels in the treatment area, but your body's regenerative processes restore normal levels within weeks to a few months. The fibroblasts that produce HA remain undamaged, and the enzyme's effect is localised and transient.
You won't look worse than before you had fillers — you'll return to your natural baseline. However, it's crucial to recognise that if you've had fillers for several years, your natural baseline has shifted due to the inevitable march of time. The bone resorption, fat redistribution, collagen loss, and skin changes that occurred during that period are not caused by filler dissolution — they're the result of biological ageing that was happening all along, merely masked by the volumising effect of the filler.
When someone feels they look "worse" after dissolution, they're usually experiencing one of two things:
The revelation of accumulated ageing that occurred whilst fillers were in place
Adjustment to their natural appearance after becoming accustomed to enhanced features
Neither of these represents tissue damage or permanent HA depletion.
The key to a successful dissolution experience is threefold:
Realistic expectations: Understand that you're returning to your current natural state, not your pre-filler state from years ago
Adequate healing time: Allow 2–3 months for full HA regeneration and tissue settling before making further treatment decisions
Supportive aftercare: Nourish your skin through proper hydration, nutrition, sun protection, and gentle skincare to optimise natural regeneration
If you're considering filler dissolution, discuss your concerns openly with a qualified practitioner who can assess your individual situation, manage expectations realistically, and support you through the healing process. Remember: hyaluronidase is a tool for correction, not destruction. Your face will heal, your natural HA will regenerate, and you'll return to your authentic self — which, whilst it may show the natural effects of time, is not damaged or diminished by the dissolution process itself.
Book Your Consultation
Ready to take the next step? Whether you're considering filler dissolution or exploring other aesthetic treatments, we're here to help you achieve your goals with expert guidance and personalised care.
During your consultation, we'll:
Assess your individual concerns and treatment history
Discuss your aesthetic goals and expectations
Create a bespoke treatment plan tailored specifically to your needs
Answer all your questions in a supportive, judgement-free environment
Provide honest, evidence-based advice about the best approach for you
Every face is unique, and so is every treatment journey. We believe in creating individualised plans that respect your natural features whilst helping you feel confident and comfortable in your own skin.
For more information and a bespoke treatment plan, book a consultation with Dr Arun Karwal at Karwal Aesthetics Mayfair, London.
