How Does the Dermal Filler Dissolving Process Work?

Most people arrive at the idea of dissolving filler with a degree of apprehension. It can feel like an admission that something has gone wrong, and it is rarely a decision made lightly. Understanding exactly what happens, step by step, tends to make the prospect far less daunting. At Karwal Aesthetics we treat dissolving as a careful, considered procedure in its own right, not as an afterthought or a quick reversal, and we would rather you understood it properly before you commit to it.

Before Anything Is Dissolved

The first appointment is a consultation, not a treatment. Dr Karwal will discuss what concerns you, what filler you have had, where it was placed and when, and what you hope removal will achieve. Your medical history is reviewed, including any allergies and any previous adverse reactions to filler or to dissolving.

This conversation matters more than it might appear. Patients frequently do not know what product they were given, how much, or in which plane it was placed. Records are often unavailable, particularly where treatment was carried out abroad or by a practitioner who is no longer contactable. Filler can also migrate considerable distances from where it was originally injected, and it can persist for years longer than the manufacturer's stated duration.

It is also worth knowing that hyaluronidase only dissolves hyaluronic acid fillers. It has no effect on permanent or semi permanent products such as polymethyl methacrylate, silicone, calcium hydroxylapatite or polylactic acid. If there is any doubt about what you have had, establishing that first is essential, because dissolving is not an option for every product on the market.

Ultrasound Assessment

Rather than working from an assumption about where filler is likely to sit, Dr Karwal uses ultrasound to look. Imaging identifies the location, depth, volume and character of existing product, and can distinguish hyaluronic acid from other materials and from surrounding anatomy. It also shows the position of nearby vessels.

This changes the treatment considerably. Filler that has migrated to a plane nobody expected can be found rather than missed. Product that a patient assumed had long since resolved is often still clearly visible. And once the location is known, the enzyme can be delivered to it directly.

The Dissolving Procedure

The treatment area is cleansed thoroughly, and topical anaesthetic may be applied for comfort.

Hyaluronidase is then injected into the filler itself, using a needle or a cannula depending on the site and the depth of product. Ultrasound is used during the procedure to guide placement, which means the enzyme goes where the filler is, at the dose required to break it down, rather than being spread liberally across the region in the hope of reaching everything.

That distinction is the reason imaging is worth the additional time. Dissolving without guidance tends to involve larger volumes of enzyme covering a wider area, which disturbs more of the surrounding tissue than is necessary. Working under ultrasound allows a more conservative approach, and it allows Dr Karwal to confirm at the time of treatment whether the product has responded.

The enzyme begins acting on contact.

What Happens Afterwards

You can return to most normal activities immediately, although strenuous exercise is best avoided for the first day or two.

Swelling, redness and bruising are common in the first few days and settle without intervention. The filler continues to break down over the following twenty four to forty eight hours, so the area will keep changing during that period. Written aftercare instructions are provided.

It takes longer than most people expect for the true result to appear. Swelling can mask the outcome for one to two weeks, and the tissue continues to settle beyond that. We review you at two weeks to assess how much product has resolved, address any concerns, and decide whether a further session is needed. Some fillers, particularly older, highly cross linked products or large volumes, require more than one treatment to clear completely.

We would strongly advise against making any decision about new treatment until several months have passed. Your own hyaluronic acid regenerates during this period, and the face you see a fortnight after dissolving is not the face you will have at three months.

How Hyaluronidase Works

Hyaluronidase is an enzyme that breaks the bonds holding hyaluronic acid molecules together. The fragments are then absorbed and metabolised by the body through ordinary processes.

It is important to be honest about one thing here, because it is the source of most patient anxiety and it is often glossed over. Hyaluronidase does not distinguish between injected filler and the hyaluronic acid your own body produces. Some natural hyaluronic acid in the immediate treatment area is broken down alongside the product. This is a local and temporary effect. The enzyme is cleared within a day or two, the fibroblasts that produce hyaluronic acid are not harmed, and your own levels regenerate over the following weeks to a few months. Your capacity to produce hyaluronic acid is entirely unaffected.

Precise, ultrasound guided placement means less enzyme is required, which in turn means less of your own hyaluronic acid is affected in the first place.

Safety

Hyaluronidase has been used in medical practice for decades and has a well established safety profile. It is highly effective at dissolving hyaluronic acid filler, and the process is reversible in the sense that new filler can be placed later should you wish, once the tissue has fully settled.

There are risks, and they should be stated plainly. Allergic reaction to hyaluronidase is uncommon but recognised, and in rare cases can be severe, including anaphylaxis. Excessive or poorly targeted enzyme can affect more tissue than intended. Swelling can be pronounced, particularly around the eyes and lips.

Dr Arun Karwal is a GMC registered doctor whose background is in emergency medicine, and dissolving at Karwal Aesthetics is carried out with the protocols, equipment and experience to manage an acute reaction should one occur. This is not a treatment that should be undertaken casually, and it is not one that should be undertaken by someone unable to manage its complications.

Discussing Your Options

If you are considering having filler dissolved, whether because of migration, overfilling, lumps, a poor result, or simply a wish to return to your own features, the most useful first step is to find out what is actually there.

Dr Arun Karwal offers extended consultations at Karwal Aesthetics in Mayfair, London, with ultrasound assessment to identify existing filler before any decision is made about removing it. You will receive an honest account of what dissolving can and cannot achieve in your particular case, in a relaxed and judgement free setting.

Consultations can be booked online.