How to correct filler injections gone wrong


Chances are if you’re reading this article right now, you’re freaking out about your recently injected hyaluronic acid filler. Thoughts, such as – What have I done to my face?! Why is there a bump there?! Or OMG my lip filler is lopsided!? – are running through your mind paired with obsessive trips to the bathroom mirror to stare, assess and unfortunately escalate your anxiety. But fear not, one of the reasons why hyaluronic acid fillers are so popular among practitioners and patients is because of the ability to correct any lumps, bumps, or asymmetries with the enzyme hyaluronidase. To learn more about this magical dissolving enzyme I reached out to Beverly Hills based Cosmetic Surgeon, Dr. Andre Berger, MD to get the full scoop on how exactly hyaluronidase works.

Which fillers can hyaluronidase dissolve?

Can dissolve – “We use hyaluronidase to dissolve hyaluronic acid filler. That would include Restylane, Perlane, Restylane Silk, Juvederm, Juvederm Ultra, Juvederm Ultra Plus, Volbella, Voluma, Belotero.”

Can’t dissolve – “It wouldn’t work for non hyaluronic acid fillers, like Radiesse or Bellafill or silicone.”

How long does it take to work?

“One of the important points to understand is that not all hyaluronic acid fillers are the same and hyaluronidase works differently with each one. The most important factor in determining how it will act has to do with the G-prime. (The G-prime simply relates to the characteristics of the filler.) The higher the G-prime the more volumizing the filler is and the thicker it is. Hyaluronidase does not work that well on the high G-prime hyaluronic acid fillers compared to how well it works on the low G-prime fillers.”

Difficult to dissolve – “An example of a high G-prime filler would be Voluma. Voluma is used for volumizing large, deep volume areas, like the lateral cheeks. Sometimes you have to use buckets of hyaluronidase, I use this analogy to exaggerate, but it almost seems like that to dissolve a high G-prime filler like Voluma. It takes a hell of a lot, it’s difficult to do and there’s a high likelihood that you aren’t going to get it all dissolved in one sitting.”

Easy to dissolve – “Something like Juvederm Ultra or Restylane on the other hand have a lower G-prime and are much easier to dissolve and can be done usually in one session. Those fillers will dissolve fairly immediately. Sometimes you can see all of it, say the lip filler, disappear by the time the patient leaves the room.”

Can you spot dissolve?

Yes and no – “You can try to target, but the precision is not like a bullet. Hyaluronidase does disseminate a little bit. It’s not like you can just absolutely stop it at any point because it will spread out in the tissue a little bit, but if you don’t overdo it and you’re careful you can target dissolve what you’re targeting.”

Will it dissolve the natural hyaluronic acid in my skin?

Yes, but not forever – “When you inject the hyaluronidase you are going to dissolve the filler that was put in that you are targeting and surrounding that you are also going to dissolve some of the natural hyaluronic acid in your skin. However, the good news is that the natural hyaluronic acid keeps being produced by your cells, so you’ll replace it pretty quickly. It’s not a permanent or long term effect.”

What if the filler dissolves unevenly?

“There’s a chance you may not dissolve everything, but thats not a big deal because you can go back the next day and add more.”

And what if I want to add filler back in once my (lump, bump, or asymmetry) has been corrected?

“To do it the right way, I recommend using the hyaluronidase to get rid of what you want to get rid of first. There is always a chance to have some swelling, redness, or pinkness from the hyaluronidase, but this will dissipate within 24-48 hours. Once all of that has gone away, you can start with a fresh new baseline and refill if you want.” 

Some fillers are better for certain areas. Read which is best where here or if you already know, read about the new hyaluronic acid lip filler – Volbella – that induces less swelling and looks more natural here

-by Amy Chang
Image source: diaboliques