Blog, Dissolving Fillers


Hyaluronidase for fillers Hyalase, Vitrase, Hylenex

Today let’s talk about a very special product and its very specific indication – hyaluronidase for fillers.

Like a lot of people, you may have considered making a change to your appearance by getting your hair cut. It’s also very possible you didn’t go through with it. It’s easy to understand what may have held you back: once the stylist cuts the hair, she can’t just glue it back. You have to take a risk and hope you like the results. If you don’t, you can’t really do anything about it except wait weeks or months for your hair to grow out.

You may have put off getting hyaluronic acid fillers because of a similar fear of being stuck with results that aren’t what you hoped for. The good news is that, unlike haircuts, the effects of dermal fillers based on hyaluronic acid can be reversed. Aesthetic beauty professionals do that with an enzyme called hyaluronidase.

Even people who’ve had plenty of experience with botox and fillers often don’t stop to think about what they’re made from. Facial filler formulations are based on different substances, and manufacturers market them under different brand names. These include calcium hydroxylapatite (Radiesse), poly-L-lactic acid Sculptra and Lanluma and hyaluronic acid such as Restylane and Juvederm.

In their practices, doctors frequently favor hyaluronic acid-based fillers, considered the gold standard among fillers. The existence of hyaluronidase is one of the reasons why. Hyaluronidase makes it possible for them to partially or totally undo the outcome of their patients’ treatments. If you receive injections of non-hyaluronic acid products, time is the only cure for unsatisfactory results. It will take months or years for those fillers’ effects to disappear. This advantage sets hyaluronic acid fillers apart from those made with other materials.


Hyaluronic acid is a carbohydrate. It’s made up of sugar molecules bonded together and is naturally present in the human body. When doctors inject a filler made with hyaluronic acid into a patient, this carbohydrate attracts water to that area of the face or body. This creates plumpness. That’s why doctors use it to compensate for the loss of volume that we all experience as time goes by. They also use it to fill wrinkles. The effects are not permanent. Injected hyaluronic acid disintegrates on its own after a certain number of months or perhaps years. Once it breaks down, the effects of the filler treatment are no longer noticeable.

Hyaluronidase is an enzyme that breaks down the hyaluronic acid molecule and degrades it. It works by breaking up the bonds that hold the sugar molecules together. This leads to hyaluronic acid’s reabsorption and disappearance. Doctors administer hyaluronidase injections when they want this break-down-and-reabsorption process to happen in a matter of hours or days instead of months or years.

Receiving hyaluronidase is very simple and relatively painless. It’s very much like the experience of having dermal filler treatment. The doctor will inject small amounts of hyaluronidase for fillers into the specific affected areas. The treatment zone may be a more sensitive one, like the area around the lips. In that case, the doctor will offer to first apply a numbing cream or topical anesthetic.


Even experienced doctors who specialize in aesthetic medicine see a small percentage of dermal filler cases where the patient’s body reacts in an unforeseen way. Often, there’s no apparent cause. Every patient is different. There will always be variations in the tissues or anatomy; this can lead to a filler acting contrary to what the doctor expected.

The issues practitioners most frequently see that prompt them to inject hyaluronidase are:

  • Excessive or long-lasting post-treatment swelling, also known as edema.

Despite how safe they are, hyaluronic acid fillers can lead to persistent inflammation. An example would be the area around the eyes, where the skin is often loose. As the hyaluronic acid starts attracting water to this zone, the resulting accumulation can give the appearance of bags or bulges on the eyelids or under the eyes. Puffiness after filler treatments is not unusual, but it shouldn’t last more than a week or two. If it does, the doctor may use a hyaluronidase injection to eliminate the deposit of hyaluronic acid. Since that’s the origin of the problem, the inflammation then goes down.

  • The Tyndall effect.

When used to correct dark circles, hyaluronic acid fillers can give rise to something known as the Tyndall effect. The term refers to a bluish or violet discoloration of the skin that some people perceive after having filler injected in the under-eye area. It’s caused by light reflecting off of filler that was placed too superficially. In these cases, it may be best course of actions to dissolve filler.

  • Overcorrection and asymmetries.

Especially when having filler injected to create volume, patients can end up with overfilled lips or cheeks. Results that are uneven, or asymmetrical, can leave a patient with one side of her face noticeably different from the other. Doctors can resolve both of these situations via hyaluronidase injections.

  • Lumps and bumps.

Bumps are likely to form in areas where the skin is thinner or that experience more muscle movement. A practitioner usually remedies this by massaging the area. But if afterwards there are lumps that still haven’t dissolved, she can treat them with hyaluronidase.

  • Filler migration.

Rarely, filler migrates to an area away from the injection site and ends up where it wasn’t meant to be. The solution is usually to dissolve filler.

  • Resolving patient dissatisfaction with the aesthetic outcome.

The truth is, practitioners sometimes administer hyaluronidase for fillers because the patient isn’t happy. It’s important for doctors and patients to talk and set realistic expectations for the results of the procedure. Even with clear communication, a patient can still end up dissatisfied. So, doctor and patient may both decide it’s best to dissolve the injected product and start from scratch.

Possible complications

Finally, there are very rare instances of complications during hyaluronic acid filler treatments. In these cases, doctors need to immediately reverse the effects of the filler they have injected.

  • Vascular compression or blockage occurs when filler interferes with blood flow because it’s unintentionally injected too close to a blood vessel. Certified, experienced physicians don’t frequently see this situation. Still, if it occurs, it’s an emergency. Tissues that don’t receive oxygen via blood flow start to die. If a doctor observes this happening, he will inject hyaluronidase on the spot. This dissolves the filler quickly so that blood flow is restored back to normal.
  • Another uncommon occurrence is when a patient has an allergic response to hyaluronic acid. Being a biocompatible substance, it’s extraordinarily rare for this to happen. Doctors usually manage these reactions with antihistamines or corticosteroids. However, they sometimes do find it necessary to dissolve filler with hyaluronidase.


It’s true that having a way to reverse the effects of hyaluronic acid filler injections makes many patients feel better. They’re less fearful, especially if they’ve never had facial fillers before. Yet, after learning that practitioners see a need to keep hyaluronidase on hand, it’s only natural to wonder if having dermal fillers is a good idea. Why have something done that might need to be undone?

If you feel this way, you can rest easy. The use of hyaluronidase is rare. Most patients are quite happy with their outcomes. To ensure you don’t turn into a dissatisfied customer, make sure to see an experienced, qualified, and reputable injector. It’s the best way to protect yourself from the consequences of mistakes that non-expert injectors are more likely to make. The product itself has a long track record of safe and effective use, as the FDA approved hyaluronic acid fillers in the early aughts. Properly administered, they produce discreet, natural-looking results.

Nowadays, the number of filler treatments performed is high, and their use has become widespread. Aesthetic medicine is not an exact science. So, statistically speaking, some cases of less-than-satisfactory results are inevitable. Luckily, doctors have an excellent solution at their disposal in the form of hyaluronidase for fillers.

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