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As a nurse practitioner, and educator, and a business owner I often wonder what it is you want to know, how can I best guide you to understanding and feeling like your part of the process? How can I learn what burning questions you have in your head so that I can respond? Then BAM! I get one or two text messages asking the same thing and I have my next blog subject!

Pressing inquiry this week: Can filler be dissolved?

Accurate (though irritating) simple answer: maybe? But there’s a little more to it than that.

First let’s talk about filler in general. Most of the volumizing fillers used in the United States are made of Hyaluronic Acid (HA, a kind of sugar molecule) as its core base. It’s pretty similar to the HA your body makes naturally with a few scientific modifications to make it softer, firmer, stretchy, last longer, etc. Ever have the feeling that you’re shriveling up as you get older? Well, you’re making less natural HA as you age, that’s part of the situation.

In addition to making HA, your body makes and enzyme that is designed to break down HA called hyaluronidase. The amount of that enzyme that you make can be different than your bestie, so you will both metabolize things differently. So, a combination of the type of HA filler used, what those scientific modifications were (i.e. how soft or stiff the filler was to start with) and knowing about this enzyme is key to the whole how-long-will-it-last and the can-it-be-undone thing.

Other fillers cannot be reversed. Fillers like calcium hydroxyapatite, polymethyl methacrylate (PMMA), biogels or poly-L-lactic acid, cannot be easily undone with hyaluronidase and may require surgery or a tincture of time to reduce.

Those of us who provide HA filler services keep on hand the pharmaceutical equivalent of your natural hyaluronidase (sold under a few different brand names). The primary reason we carry it is a safety release in event of an injection concern. But more and more we are using it to expedite filler dissolving to start fresh. Pillow face is OUT (thank goodness), as is the trout pout (phew!). So for those who need to rediscover what they were before they went overboard, we can help them get there quicker than simply waiting for their own body to degrade it over a variably predictable amount of time.

If you’re in a situation where you liked the HA filler you received, but it’s no longer your thing, or it’s moved, or it’s swelling more than it did because it’s in its breakdown phase and you want to kick it out faster, yes—I can inject hyaluronidase in the region of question. This is technically an off-label use of the product, but remains within industry standards.

And while you are contemplating this as a personal option, I want to share a few things with you about the process to help you decide if you want to go in that direction:

  1. As HA filler breaks down it can grab hold of more water (after all, the sole reason for HA to exist is to hold on to water—about 1000 x it’s weight). This is felt to be part of the reason you can see an increase in swelling occur even years after filler was originally injected.

  2. Hyaluronidase is an enzyme with no clear on-label use for dissolving HA filler. When hyaluronidase is injected, it's a bit uncomfortable (I say spicy, some say “hurts like heck”). I can add a little lidocaine to help, but it still stings a bit.

  3. The injector cannot completely or exactingly control where it goes as it’s injected. It’s a very thin liquid and it travels wherever it wants within the area being treated. Of course, we certainly do our best to focus it to the area of swelling and desired breakdown.

  4. Your body makes hyaluronidase and hyaluronic acid, but everyone has varying amounts of both. The enzyme breaks down all hyaluronic acid, including that which your natural HA. Most of the effect is immediate, though ongoing reduction can be seen for up to a week or so. Most injectors will not inject hyaluronidase and new HA filler on the same session.

  5. Hyaluronidase is sold by the unit or the vial, depending on who you see for treatment. It is most common for me to start with one vial, inject, then reassess 2 weeks later. You may need repeat treatments to get you to your goal, or you may not—we just have to be patient, wait and see.

  6. If you seek reversal because you are frustrated by an increase in swelling near a region where filler was previously placed, remember the swelling could be something other than filler. One such example is impaired lymphatic drainage (from infection, injury, age, trauma, radiation, surgery)—so injecting hyaluronidase is not a guarantee the swelling will completely resolve.

Before we go, lets address the elephant in the room. Filler migration. Ain’t gonna be no finger pointing by me…unless you do the dirty and self-inject, or don’t heed the chill-out rest instructions we give as you depart (particularly with lip filler). Filler migration can result as a result of many different things, and in my professional opinion, is more likely a little bits of more than one thing. Remember HA fillers are gel. And we’re placing them in a hidden region that has layers of tissue and muscles that squeeze (some areas this is nearly constant). You talk, kiss, chew, suck on a straw, you put your face into a massage ring, your eyes dart around even when you’re sleeping. Fillers are manufactured in varying consistencies too, from relatively thin to thicker and sticky dependent on where we are placing them and what end goal is desired. How well they integrate with your own soft tissue is part of it. Technique used to inject can also play a role. And then there’s the natural break down process too. Guaranteed no injector purposely mis-guides, mis-selects or mis-injects you on purpose. But we also have varying levels of experience and varying degrees of how much continuing education we pursue. Long story short, don’t coupon your face. Duh!

Of course, this isn’t meant to answer ALL your curious questions, but heck…we have to start somewhere! You can check out the Prescribers Digital Reference or the Food and Drug Administration on any ol’ pharmaceutical product you want all the details for.

Whether you know me already or are just checking out my services (and attitude) you need to know I’m a local girl with an aesthetic eye toward natural beauty. My favorite thing to do is enhance features my patients already have, maybe just make them look more rested, or shave a few years off. I’m decidedly against pillow face!

Often my peeps come to see me for a little wrinkle relaxation to start, then they return and they have one or two curious questions like: “what would you do for this?” (while pointing at their cheeks, or jowls, or nasolabial folds, or marionette lines, or simply pulling back their entire face). I’m happy to help guide decision making, but I’ll never over sell something I don’t think jives with your look, your anatomy, or your goals. I don’t know about every product or device out there, but I do hear stories and am happy to give you my thoughts on even things I don’t offer myself. When I add something to my line up it’s after careful research, but sometimes I bring on a service too that I end up feeling isn’t all it was cracked up to be, and I’ll admit that too!

All that being said—one of my go to recommendations (and a solid “hell yes!” product) continues to be poly-L-lactic acid which is sold under the brand name Sculptra in the United States. Sculptra has been around for 20 years and comes from a very interesting beginning (you should ask me about it). Why do I like this treatment? #1 It’s a filler that’s not a filler, it triggers your OWN collagen growth. #2 It provides what I call global enhancement—where a syringe of filler is good for a specific target area (like lips). That means your whole face looks fresher, younger…but not overdone. #3 Even when injected deep, it helps give the skin a lovely glow. #4 It’s one of the few treatments that can help give your peripheral face a little pull (think temple area, and the crepey skin you start noticing in front of the ears, or even smile lines in your lower cheeks). Much of aging is from chronic UV exposure and from collagen loss which starts at about age 30, and doesn’t come back without a gentle nudge. Sculptra is a great nudge!

Poly-L-Lactic-Acid comes as a powder which is then reconstituted with sterile water and usually a little lidocaine by the provider. It is then injected based on what is seen during our assessment. There are on label indications, and different ways (off label) of getting there, but for me commonly areas treated includes the temple, the cheeks, near the nose, the hollow by the chin and near the corner of the jaw. After injections you’re numb for about 15-30 minutes. You’ll feel a little puffy due to the water, but that is resorbed over the next several days. One of the most important parts of after care for you includes massaging—5 minutes, 5 times a day, for the first 5 days. Why? Massage encourages the little particles to float uniformly in the tissue until the water is all resorbed, and reduces the risk of developing a nodule (which is just collagen, and no big deal). When the water is absorbed you might initially think “what was that for? I don’t see anything!”—but that’s precisely when the magic is happening. Your body then sees the teensy-weensy particulate, it goes to work to extract it while replacing it with your own collagen! That improves the “fluff” in your skin, and once you’re corrected appropriately, you will notice improvement for up to two years.

On average I recommend 2 vials x 2 sessions spaced 2 months apart (give or take). Another vial or two might be suggested but I usually wait for about 4-6 months before I make that decision because your collagen growth takes time to be seen and appreciated. So, for the money you invest in Sculptra as a solid foundation to revitalizing your face, you’ll have a reduced need for hyaluronic acid fillers (translation, eventual savings) that can still be used to add contour, or fluff the lippies, or what have you.

Like most injectables it is not advised to be used in pregnancy, lactation or if you have a tendency to keloid or hypertrophic scarring. Also, not a first choice for those with a flair or compromised immune systems— (funny strange though, it was developed to bolster confidence and quality of life for patients suffering significant immunocompromise in the 1990’s). It takes special training to inject this product well –so be sure you know who you’re going to when you take the leap!

Most common side effects are swelling, tenderness, redness which last for a few days. Bruising, bleeding, itching and bumps can also occur. It is not used around the eye or in the lips due to the constant motion of those muscle groups.

I’m on my own Sculptra journey—I practice what I preach. I had my first session in October, and my second in December of 2022. I’m now in chill mode waiting to see if there is more in my future but I can tell you I’m not pillow face, and my jowls don’t distract me the way they used to. I’m happy with what I see so far, and I do it for me not for anyone else. That makes it a total win in my book.

So, if you ask me a curious question and I think it’s the right answer and appropriate for your precious face, don’t be surprised if I hand you a Sculptra brochure and ask you to do a little research (full product details can be found on I want you to stay you for as long as possible!

Just to keep you in the know, we took a look at some of our policies and have upgraded them for efficiency and service. Part of running a business is to constantly take a look at what works, and what doesn’t. We want to do right by each of you and provide exceptional care when you are in our chair! So, take note, all are in effect as of 1/1/23.

Neurotoxin Appointments: The current trend is to charge for toxin treatment "by the area", rather than the unit. I'm not super keen on that concept, though it's a solid business move and I understand why it's hot. We will be sticking with per-unit pricing at RediscoverdU, but minimum number of units per session will be 25 (Botox equivalent units), up from 20. A baby nudge to keep the doors open. So far, there has not been any announcements from manufacturers regarding planned increase in cost like we saw last year...let's keep our fingers crossed!

Time is precious, so let's mutually respect one another's! A valid credit card is required to be on file to hold time for your visit. Think of it as a pinky swear, you'll be there. It doesn't get charged unless changes are made less than 48 hours from a scheduled appointment. Late change or no show will be charged and/or invoiced at $100 per 30 min booked. Bummer for sure, but an empty chair means someone else couldn't come, and drives up overhead. The full policy can be found on our website, and Is part of your booking confirmation as well. No exceptions. If the cc on file fails to run, I’ll send an invoice via QuickBooks that you can pay online—once done, you’ll be free to rebook. Please let me know If you have any questions.

While a standard tox treatment has a 25 unit minimum, dose adjustment appointments do not. We sure try to get It right the first time, but if you need an adjustment tweak It can be done between 2 and 4 weeks from your original session and will be charged per-unit (no freebies). If you go beyond 4 weeks from your original treatment, you'll be asked to wait until your next full session so that we limit unnecessary exposure to medication and don't leave you with weird wear-off patterns that are impossible to predict. No one wants self-induced tox-resistance!

Yes! We offer virtual consultations! If you're not sure what options are best for you after you've taken a look at our website and read our very crafty blog posts, you can totally book a consultation for customized planning! The fee for consult Is $75 for 30 minutes: that gets you the best of my medical specialty brain, and you can ask me anything you'd like! I'm not here to upsell, I simply want to learn about you, your lifestyle, your goals, and what services match your individual style. If I think you're better suited for a service we don't offer at RediscoverdU, I'll tell you that too!

Our HIPAA compliant patient portal keeps all your information safe, and allows you to schedule and reschedule your appointments 24/7 (since we aren’t open every minute of every day, and we have a 48-hour change policy, it’s beneficial to you to adjust on your own to avoid late fees). However, it’s just computer software, and sometimes the algorithm isn't very friendly to sneaking things in. Please do what you can online, as we prefer to tend to YOU when you're in the chair Instead of fussing with the phone... but if you get stuck you can always text the business line and we'll do what we can to find you a spot or reset a password or see if we can tuck you into a hand-crafted spot! 360-994-0565

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