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Looking to undo? Hyaluronidase might be an answer.

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.

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