Dissolving Your Filler: An Expert Answers Your 5 Most Common Questions

There’s certainly been tons of discussions around having – or not having – filler recently, including, rather concerningly, ‘will dissolving your filler ruin your face?‘ That’s the sort of headline none of us wants to see! Alice also asked Mr Daniel Ezra a bunch of questions for her recent MRI article, and, of course, there wasn’t room for half of the fascinating stuff that he said. So here are five commonly asked questions about dissolving or breaking down filler, presented in straightforward Q&A format, which we thought you guys might like to see…

1. Are there any energy devices or treatments that can help break down filler?

“It’s very unclear whether devices can break down filler injections,” says Mr Ezra. “Massage can certainly be helpful to disperse filler, particularly those which are less cross-linked through the tissues. This won’t dissolve the filler, but it will help to decrease the prominence of lumps, bumps, and other irregularities.”

Mr Ezra also regularly uses the Endolift diode laser to help break up unwanted filler down if required: “This is laser delivery under the skin, which can be directed into the soft tissue planes to break up hyaluronic acid fillers. Hyaluronic itself can be cleared from the tissues, but the filler molecules are initially too large to be cleared, particularly as they are cross-linked and form larger particles. But, if the hyaluronic acid is broken down well enough, the body’s normal mechanisms will clear foreign bodies.”

2. Does hyaluronidase break down filler thoroughly, or is this untrue?

There’s a bit of nuance here…

“Hyaluronidase breaks the bonds between the chains of hyaluronic acid, which is usually highly effective in creating smaller sizes for the body’s cells to naturally clear these smaller particles,” reveals Mr Erza.

“However, with a more heavily cross-linked hyaluronic acid, it is sometimes more difficult to break down the filler material into small enough pieces for the body cells to digest and remove. This is particularly true for some of the older fillers, which tend to be more heavily cross-linked,” Mr Erza continues. “In addition to this, our studies of human tissue in regions where filler has been rejected do show that there is significant scarring and inflammation in these areas. The filler can become surrounded by scar tissue, which is the normal way the body deals with warding off foreign materials. This can make it difficult for the hyaluronidase to penetrate, and it also makes it more difficult for the body’s cells to clear these encapsulated areas.”

For that reason, you should not see dissolving filler as a ‘get out of jail free’ card that allows you to overexperiment/overinject with filler. A careful approach that keeps you happy with your result consistently is by far the best!

3. Can hyaluronidase make a bad filler situation worse?

Unfortunately, “it certainly can,” suggests Mr Ezra. “Our studies looking into the largest number of hyaluronidase filler-dissolved patients ever published clearly demonstrated that there is approximately a 20% risk of developing post-hyaluronidase syndrome. Meaning that the aesthetic impact of the dissolving is worse than before the filler was injected. It is unclear whether this is due to the hyaluronidase itself or whether it is due to tissue changes arising from the filler, which is simply unmasked after having the filler removed.”

Again, though, this is a risk that can be minimised by having a moderate and considered approach to filler injections in the first place.

“The key risk factors for developing problems like post-hyaluronidase syndrome are high volumes of filler and filler that has been in the tissues for a longer duration,” says Mr Ezra. “That’s why we always counsel patients regarding these risks and tell them that there is a possibility that there might need to be some form of rebuilding and repair phase after dissolving. That might involve us offering more treatments to address some of the damage caused by the cycle of filler placement and dissolving.”

4. What do facial MRIs actually show?

You might have seen Alice’s recent second MRI showing how much filler is reportedly still in her face. But MRIs aren’t only visually interesting / perhaps a little scary.

“We tend to use facial MRIs to help counsel patients on whether or not to have the filler removed. It is a very useful tool,” says Mr Ezra. “Given the potential difficulties with filler dissolving, it is essential that patients are fully informed of the risks and benefits, and MRI imaging is one variable in that equation. It is essential for us to put the patient at the centre of the decision-making process. Patients will also ask for MRIs to simply get a snapshot of their facial filler status, often after many years of injecting. This is often very helpful to reconcile their symptoms of ageing with the locations of filler.”

5. Are you seeing an increase in people wanting filler dissolved?

The short answer is yes! But, for various reasons…

“We have seen an enormous spike in people wanting to remove filler,” reveals Mr Ezra. “This ranges from wanting to address complications like swelling or lumpiness, but also, for those who have just decided they do not want any foreign material in their face, even if they are not having any symptoms from it. One of the doctors in our clinic runs a filler dissolving and complication clinic, and we have enough patients to keep this a regular clinic throughout the year. In fact, on a weekly basis, we are one of the busiest filler dissolving practices in the UK.” (Mr Ezra’s clinic is on Harley Street in London, just so you know).

Ultimately, if you are considering dissolving your filler, the main thing to remember is to go see an expert! The reason: “Dissolving filler is a highly specialised area and a clinic should not be able to take in patients without a deep understanding of the nature of filler dissolving, its consequences and how to best counsel patients who are considering this treatment.”

Looking for more advice on tweakments, skincare and finding an expert practitioner? Head to The Guide for all our recent articles.