Raise your hand if you’ve experienced buyer’s remorse. The feeling that is familiar to many is not just reserved for retail therapy — it can happen post-aesthetic treatment, too. Results don’t always live up to expectations, and, in certain cases — specifically minimally invasive injectable treatments that temporarily alter the appearance — waiting for the results to dissipate can feel like an eternity.
Hyaluronic acid (HA)-based dermal fillers, like Juvéderm®, Restylane®, and Belotero®, naturally dissolve over time depending on the treatment area, the amount injected, and the patient’s metabolism (for men, it will likely dissolve faster). Those who are left feeling dissatisfied with their results, however, will be relieved to know that turning back time is an option. Enter: hyaluronidase.
Whether it’s the lips, under the eyes, in the cheeks, or any of the other areas where HA filler is placed, injecting hyaluronidase can speed up the degradation process and reduce plumpness and/or lumpiness in a matter of days. But is the revision really as simple as it sounds? We tapped two top dermatologists to break down everything you need to know about hyaluronidase.
What Is Hyaluronidase?
Like hyaluronic acid, the human body naturally produces hyaluronidase. “Hyaluronidase is an enzyme that occurs naturally in the body to break down hyaluronic acid, which is a naturally occurring molecule that helps give turgor and support to our skin and joints,” explains Daniel Belkin, MD, a board certified dermatologist at New York Dermatology Group.
Just as we can inject synthetic forms of hyaluronic acid to augment and contour the face and body, we can inject synthetic forms of hyaluronidase to undo the effects. “[It] can be synthetic and used deliberately for the non-surgical removal of unwanted effects of a HA filler treatment,” says Jessica Weiser, MD, a board certified dermatologist and founder of Weiser Skin MD. “Beautifully placed filler can be wonderful, but poorly placed or excessive amounts can be a struggle to correct.”
How Hyaluronidase Is Used
As you may have predicted, hyaluronidase is a way to revise HA filler procedures that go awry for any number of reasons. “Because HA is the essential component of HA-based fillers, hyaluronidase may be injected into the skin by a dermatologist or plastic surgeon to rapidly dissolve filler,” Dr. Belkin says. This correction may be due to “a poor cosmetic outcome” or “for a complication,” he adds.
Yes, hyaluronidase can help remove volume or soften contour for patients who are unhappy with the outcome of their injectables, but it can also address some of the possible side effects of HA filler — chiefly, lumps and nodules. “The same applies to hyaluronidase for small bumps and blebs,” Dr. Weiser shares. “I will often start with diluted hyaluronidase to see if I can reduce excess product or product placed too superficially without wiping out everything.” In other words, a skilled injector may be able to smooth lumpiness without compromising the rest of the result.
When Will You See Results from Hyaluronidase?
Depending on your condition, hyaluronidase can be a relatively quick fix. “It often works to dissolve or partially dissolve HA filler in less than an hour,” Dr. Belkin says. “It may take until the next day to see the effects, though typically not more than 24 hours.” Like the temporary swelling experienced after dermal filler injections, dissolving filler may cause the treatment area to initially look even more plump. “This is because injecting the hyaluronidase requires the injection of more fluid into the area, not to mention the potential to bruise, which may leave the area looking puffy or full despite the filler having been dissolved,” Dr. Belkin explains.
Fear not: As the swelling goes down, the actual results will show in a matter of days.
What If I Want To Get Filler Again?
No matter your reasoning for dissolving your filler, a refill, if you will, is allowed in due time. After your first hyaluronidase treatment, an evaluation will be necessary to see if additional sessions are needed. All the while, you’ll want to make sure any swelling has fully resolved before going under the needle for HA filler again. “I typically would wait a week before putting new filler in to make sure swelling has resolved, and we can see the full effect of the dissolver,” Dr. Belkin says.
To ensure a more desirable outcome moving forward, Dr. Weiser recommends taking things slow. “Placing numerous syringes of filler in the face in a single appointment may be appealing right away, but it often settles poorly or leads to unnatural cosmetic outcomes,” she cautions. So, rather than going all in at once, she suggests taking a modest approach of one to two syringes (max) to start, after which more can be added upon request.
This wouldn’t be an article on The AEDITION if we glossed over the potential side effects and complications of hyaluronidase injections. Dr. Belkin notes that the primary side effects are swelling and bruising (a common occurrence post-filler, too) that tend to last a week.
It should also be noted that the dissolver may leave you with less volume than you started with because hyaluronidase can impact both synthetic and naturally occurring hyaluronic acid in the treatment area. While Dr. Belkin says that the body corrects this over time by producing more HA, it may take a few months for the atrophy to fully resolve. “To avoid this, assuming it is not an emergency, I will dilute hyaluronidase with saline to get just the right amount of activity that I want,” he shares.
Additionally, the use of hyaluronidase is not recommended in individuals who have experienced anaphylaxis, are on certain medications, or have an allergy to any component of hyaluronidase. Be sure to discuss your medical history with your provider to avoid complications.
A plump lip or a fuller cheek may provide a more youthful appearance, but, when overfilled features become a point of contention, hyaluronidase may dissolve those concerns. While the enzyme provides peace of mind for patients who experience undesirable outcomes or complications, one of the best ways to avoid the need for a revision is to take the time to find the right provider for your aesthetic goals. “Every doctor has a different technique and varying end goals,” Dr. Weiser says. “So, if your injector has a very full face, they are likely desiring to give you this same endpoint.” Her advice: “Do your research!”
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