Dermal fillers have become a popular treatment for those seeking to restore facial volume, smooth wrinkles, or enhance features without surgery. Although these injectables are temporary by design, sometimes a patient may desire a quicker reversal due to an unsatisfactory result, over-correction, or a medical complication. This process is possible, but it depends entirely on the specific chemical composition of the product that was injected.
Identifying Dissolvable Fillers
The capacity for a dermal filler to be dissolved is directly linked to its core material. The vast majority of temporary fillers are made from a substance called hyaluronic acid (HA), a sugar molecule naturally present in human connective tissue. HA fillers are the most common type used today, offering both immediate volume replacement and the flexibility of reversibility.
However, not all injectable products are based on this molecule, meaning not all are dissolvable. Fillers composed of calcium hydroxylapatite (CaHA), such as Radiesse, or poly-L-lactic acid (PLLA), like Sculptra, are examples of materials that cannot be broken down quickly with an injection. These products work by stimulating the body’s own collagen production, a mechanism that does not allow for immediate chemical reversal. Permanent fillers, which contain polymethylmethacrylate (PMMA) microspheres, also fall into the non-dissolvable category.
The Dissolving Agent and Mechanism
The substance used to dissolve hyaluronic acid fillers is a therapeutic enzyme known as hyaluronidase. This enzyme naturally exists in the body and functions to regulate the level and distribution of hyaluronic acid in tissues. When used in a cosmetic setting, the enzyme is typically derived from various sources, including recombinant human forms or animal sources like bovine or ovine testes.
Hyaluronidase works by acting as a biological pair of scissors, specifically targeting and breaking the glycosidic bonds that link the sugar molecules in the hyaluronic acid chain. This action converts the thick, gel-like filler material into smaller, fluid fragments that are easily absorbed and metabolized by the body, effectively removing the filler from the injection site. The efficiency of this process can be affected by the filler’s properties, as highly cross-linked or concentrated HA products may require a higher dose of the enzyme to access the internal bonds.
Procedure, Results, and Timing
The process of dissolving a filler begins with a consultation to determine the correct enzyme dosage and injection sites, often followed by a patch test. A small amount of the hyaluronidase solution is sometimes injected into the forearm to check for a rare but possible allergic reaction before the full procedure begins. Once cleared, the enzyme is injected directly into the area where the filler needs to be removed, which may involve a topical numbing cream for patient comfort.
Patients may notice a softening of the filler almost immediately, though the full effect of the dissolution is typically seen within 24 to 48 hours following the injection. Factors such as the volume of the filler, the product’s density, and how long the filler has been in place all influence the amount of enzyme required. Temporary side effects are common and can include localized swelling, tenderness, and bruising at the injection sites, which generally resolve within a few days.
Addressing Non-Dissolvable Fillers
For fillers not based on hyaluronic acid, such as those containing poly-L-lactic acid (PLLA) or calcium hydroxylapatite (CaHA), the immediate reversal option is not available. These biostimulatory products are designed to break down naturally over an extended period, which can range from 18 months up to a few years.
If a patient develops nodules or granulomas, which are small lumps of inflamed tissue, a healthcare provider may use corticosteroid injections to help reduce the inflammation and shrink the tissue. In very rare cases where a complication is severe or the aesthetic result is extremely unsatisfactory, surgical excision may be necessary to remove the non-dissolvable material.