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.

The filler dissolving procedure takes approximately 30 minutes and you can carry on with the rest of your day as normal. Results will be apparent immediately after your filler dissolving treatment.

Immediate Recovery (First 24-48 Hours)

• Swelling: Temporary swelling is common and usually peaks within the first 24 hours.

• Redness: The treatment area may appear red immediately after the procedure.

• Tenderness: The injection sites might feel tender to touch.

• Bruising: Some patients experience bruising that can last 3-10 days.

• Lumps or bumps: The area might feel uneven temporarily as the hyaluronidase works.

Short-Term Recovery (3-7 Days)

Most visible side effects resolve within a week after treatment:

• Decreased swelling: Most swelling subsides within 72 hours.

• Resolved redness: Any redness typically fades within 2-3 days.

• Improved comfort: Tenderness generally improves within a few days.

• Tissue remodeling: The treated area continues to adjust as the filler breaks down.

Complete Recovery (1-2 Weeks)

By the 1-2 week mark, most patients experience:

• Full resolution: All side effects have typically resolved.

• Final results: The complete dissolution effect is visible.

• Return to baseline: The area returns to its pre-filler appearance.

Following proper aftercare instructions after having dermal filler dissolved is essential for optimal healing and results. Here's what you need to know:

Immediately After Treatment (First 24 Hours)

• Avoid touching or massaging the treated area: This helps prevent infection and allows the dissolving agent to work effectively.

• Avoid strenuous exercise: Skip intense workouts for at least 24-48 hours to prevent increased blood flow to the area.

• Stay hydrated: Drink plenty of water to help your body process and flush out the dissolved filler.

First Few Days (24-48 Hours)

• Skip makeup if possible: Avoid applying makeup to the treated area for at least 24 hours to reduce infection risk.

• Avoid alcohol: Refrain from drinking alcohol for 24-48 hours as it can increase swelling and bruising.

• Take paracetamol if needed: If you experience discomfort, take paracetamol rather than aspirin or ibuprofen, which can increase bruising.

First Week

• Monitor for side effects: Some swelling, redness, tenderness, and bruising are normal. Contact your practitioner if you experience severe pain, excessive swelling, or signs of infection.

• Avoid dental work: Postpone dental treatments for at least a week if the treated area is near your mouth.

• Be patient with results: It may take several days to see the full dissolving effect. The enzyme (hyaluronidase) works gradually.

• Avoid facial treatments: Skip facials, chemical peels, microdermabrasion, and laser treatments for at least 2 weeks.

When to Contact Us

Seek medical attention if you experience:

• Severe or worsening pain

• Excessive swelling that doesn't improve

• Signs of infection (warmth, pus, fever)

• Unusual discolouration or skin changes

• Vision changes or severe headache

• Any other concerning symptoms

The number of sessions required to dissolve dermal fillers depends on several factors:

• Amount of filler present: Larger volumes of filler may require multiple sessions.

• Type of filler: Some fillers dissolve more readily than others.

• Location of filler: Areas with denser filler or in certain anatomical regions may need more than one treatment.

• Individual response: Each person's body responds differently to hyaluronidase.

Most patients require only 1-2 sessions, but some cases may need up to 3 sessions for complete dissolution. Sessions are typically spaced 2-4 weeks apart to allow for assessment of results and healing between treatments.

1. Lumps/bumps or areas of asymmetry

2. Migration of filler sometimes occurs in areas such as lips when the area has been overfilled or injected erroneously.

3. Disliking the result

4. Vascular occlusion is an extremely rare case when the filler has blocked a blood vessel.

Results are typically visible within 24-48 hours.

The recommended waiting time before re-treating an area with dermal fillers after having filler dissolved varies depending on several factors:

General Guidelines

• Minimum waiting period: Most practitioners recommend waiting at least 2-4 weeks after filler dissolution before re-treatment

• Optimal waiting period: 4-6 weeks is often considered ideal to allow complete resolution of swelling and ensure the dissolving enzyme has fully dissipated

Factors That Influence Timing

• Amount of filler dissolved: Larger volumes may require longer waiting periods

• Location treated: More delicate areas (like lips) may need more recovery time

• Individual healing response: Some people experience more swelling or bruising than others

• Type of dissolving enzyme used: Hyaluronidase typically works within 24-48 hours, but residual effects can persist

Why Waiting Is Important

• Allows complete breakdown and absorption of dissolved filler

• Ensures hyaluronidase has fully cleared from the tissue

• Permits accurate assessment of the area without distortion from swelling

• Reduces risk of complications or uneven results

After having dermal fillers dissolved with hyaluronidase, it's generally recommended to wait 2 to 4 weeks before having a second dissolving session.

Key Considerations:

• Initial waiting period: We recommend waiting at least 2 weeks to allow the hyaluronidase to fully work and for any swelling or inflammation to subside.

• Optimal timing: Waiting 4 weeks is often preferred as it gives a clearer picture of how much filler remains and allows your tissue to recover fully.

• Individual variation: The exact timing can depend on factors such as the amount of filler that was dissolved, the area treated, and how your body responds to the treatment.

• Assessment appointment: Many practitioners schedule a review appointment 2-4 weeks after the first session to assess the results and determine if additional treatment is needed.

When dermal fillers are dissolved, either naturally over time or through medical intervention, they break down and are processed by the body. Here's what happens:

Natural Dissolution Process

• Hyaluronic acid fillers: These are the most common type and naturally break down over time (typically 6-18 months). The hyaluronic acid is metabolised by enzymes in the body called hyaluronidases.

• Absorption by the body: Once broken down, the filler components are absorbed into the bloodstream and processed through the body's natural metabolic pathways.

• Elimination: The degraded material is eventually eliminated through normal bodily processes, including through the kidneys and other excretory systems.

Medical Dissolution (Hyaluronidase Injection)

• Enzyme injection: If immediate dissolution is needed, hyaluronidase can be injected to rapidly break down hyaluronic acid fillers.

• Quick breakdown: This enzyme accelerates the natural process, breaking down the filler within 24-48 hours.

• Same elimination route: The dissolved material follows the same metabolic pathway as natural dissolution.

The body treats dissolved filler material as it would any other naturally occurring substance, processing and eliminating it safely without leaving permanent traces.

Not all dermal fillers are dissolvable. At Karwal Aesthetics, we exclusively use hyaluronic acid fillers, which are completely reversible and can be safely dissolved if needed. This provides an important safety measure and peace of mind for our clients.

If you're considering treatment elsewhere, we strongly recommend verifying that your practitioner uses only hyaluronic acid fillers and avoids other types such as permanent or semi-permanent fillers. These alternative fillers cannot be dissolved and may carry additional risks.

Why Hyaluronic Acid Fillers?

• Safety: Hyaluronic acid is a naturally occurring substance in the body, making it biocompatible and well-tolerated.

• Reversibility: Unlike permanent fillers, hyaluronic acid can be dissolved using hyaluronidase if you're unhappy with the results or experience complications.

• Natural results: These fillers integrate smoothly with your tissue, providing natural-looking enhancement.

• Temporary duration: Results typically last 6-18 months, allowing you to adjust your aesthetic goals over time.

Questions to Ask Your Practitioner

Before any filler treatment, always confirm:

• What type of filler is being used?

• Is it hyaluronic acid-based?

• Can it be dissolved if necessary?

• What is the practitioner's experience and training?

Your safety and satisfaction are paramount. At Karwal Aesthetics, we're committed to transparency and using only the highest quality, reversible products for your treatments.

We offer dermal filler dissolving at our London , Mayfair clinic.

Ultrasound-guided dissolution of dermal fillers has become an increasingly preferred method in aesthetic medicine for several important reasons:

Enhanced Safety and Precision

• Accurate visualisation: Ultrasound allows practitioners to see exactly where the filler is located beneath the skin, including depth and proximity to blood vessels and other structures.

• Targeted treatment: The dissolving enzyme (hyaluronidase) can be injected precisely into the filler deposit, minimising unnecessary treatment of surrounding tissues.

• Reduced risk of vascular complications: By identifying blood vessels in real-time, practitioners can avoid accidental intravascular injection, which could lead to serious complications.

Improved Treatment Outcomes

• Complete filler removal: Ultrasound guidance ensures that all filler deposits are identified and treated, rather than relying on surface palpation alone.

• Fewer treatment sessions: More accurate initial treatment often means fewer follow-up sessions are needed to achieve complete dissolution.

• Better management of complications: In cases of filler migration or vascular occlusion, ultrasound helps identify the exact location and extent of the problem.

Specific Clinical Situations

• Deep filler placement: When fillers have been placed in deeper tissue planes, they may not be easily palpable, making ultrasound guidance essential.

• Filler migration: Ultrasound can locate filler that has moved from its original injection site.

• Emergency situations: In cases of vascular compromise, ultrasound guidance enables rapid and accurate treatment to prevent tissue damage.

• Unclear filler location: When patients are unsure of previous treatment details or multiple filler types have been used, ultrasound provides clarity.

Patient Confidence and Satisfaction

• Evidence-based approach: Patients can see the imaging evidence of filler location before and after treatment.

• Reduced anxiety: The increased precision and safety measures provide reassurance to patients concerned about the dissolution process.

• Minimised swelling and bruising: More targeted injection reduces unnecessary trauma to surrounding tissues.

Whilst ultrasound-guided filler dissolution may incur additional costs compared to blind injection techniques, the enhanced safety profile and improved outcomes make it the gold standard for many practitioners and an increasingly expected standard of care in aesthetic medicine.

Choosing ultrasound-guided dissolving before facelift surgery offers several compelling advantages that contribute to superior surgical outcomes and patient safety:

Enhanced Surgical Precision

Ultrasound guidance provides real-time visualisation of filler placement, allowing practitioners to identify and dissolve all filler deposits accurately. This precision ensures that the surgeon works with your natural facial anatomy rather than altered tissue, leading to more predictable and aesthetically pleasing results.

Comprehensive Filler Removal

Unlike traditional dissolving methods that rely on palpation or guesswork, ultrasound technology can detect fillers in deeper tissue planes that would otherwise be missed. This thoroughness is crucial because even small amounts of residual filler can affect surgical outcomes or cause complications.

Real-Time Filler Mapping and Dissolution Monitoring

By visualising the filler on ultrasound, we can precisely map its location and distribution throughout the facial tissues. Once the dissolving agent is administered, we can observe the filler breaking down in real time on the ultrasound screen, ensuring complete and effective removal.

Optimised Treatment Planning

With fillers removed, your surgeon can accurately assess your true facial structure, skin quality, and degree of ageing. This authentic baseline allows for better surgical planning and more tailored techniques specific to your needs.

Cost-Effectiveness

Although it adds an initial step, ultrasound-guided dissolving can save money in the long run by reducing the likelihood of revision procedures or treatments for complications caused by residual filler.

For these reasons, ultrasound-guided dissolving has become the gold standard amongst experienced facial plastic surgeons who prioritise optimal outcomes and patient safety.