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Removing facial fillers with hyaluronidase injection

Blog post - hyaluronidase injection reverse HA facial filler

Hyaluronidase can reverse some facial fillers used in cosmetic treatments of the lips and face.

Facial fillers continue to increase in popularity for many reasons, such as being a nonsurgical office treatment via local anesthesia and minimal downtime. Facial fillers are second only to Botox® for non-surgical facial cosmetic treatments. Injections of Botox and facial fillers are performed by all cosmetic specialists, including dermatologists, plastic surgeons, ophthalmologists, and facial plastic surgeons, while surgical procedures are performed by a smaller pool of physicians.

Sometimes, however, a patient wants the facial filler to be reversed or removed. Hyaluronidase injections are used to reduce or remove hyaluronic acid fillers. Treatment with hyaluronidase speeds the natural breakdown of these types of fillers.

As a facial cosmetic specialist, Dr. Chaboki has patients referred to him by other dermatologists, ophthalmologists, and plastic surgeons for filler reversal. He first performs a consultation and then determines if reversal is an appropriate option. For many patients, waiting an appropriate amount of time to allow normal swelling to subside resolves most cosmetic issues.

The most common reason patients want to reverse a filler is for an undesired cosmetic result. “Too much”, “too different”, “not what I expected”, “looks worse” are some aesthetic reasons filler patients want reversal. Other reasons may include asymmetry, lumps, bumps, granulomas, or nodules that are undesirable. Some patients also may develop a bluish appearance to the skin (i.e. Tyndall effect) from some fillers placed to superficially. Prolonged tissue swelling or reaction from fillers can be another reason to consider hyaluronidase.

What are facial fillers made of?

Facial fillers such as Juvederm®, Restylane®, and Belotero® are made of a material called hyaluronic acid (HA). HA is a natural component of the skin. HA fillers are a clear gel that softens facial wrinkles, augments lips, and enhances cheeks. HA fillers vary in their consistency, thickness, and longevity and are tailored for certain areas of the face. For example, Juvederm is very popular for lip injections.

Other fillers such as collagen injections, Radiesse®, and Sculptra® are made of other materials that cannot be reversed. Methods other than hyaluronidase are required to manage undesired results with these non-HA fillers.

What is hyaluronidase?

Hyaluronidase is a natural occurring enzyme in our tissue that modifies our own hyaluronic acid. Hyaluronidase injections are considered very safe and have been used for years for non-cosmetic purposes in medicine before being used in cosmetic surgery to reverse HA fillers. Hyaluronidase injections continue to be used to help speed the delivery or dispersion of other drugs. For example in ophthalmic surgery, surgeons use hyaluronidase mixed with local anesthesia to help the anesthesia spread farther.

The different trade names or brands of hyaluronidase include Hylenex®, Vitrase®, and Amphadase®, which all have the same molecule hyaluronidase.

How is the hyaluronidase treatment performed?

The technique of hyaluronidase treatment is very quick. A small needle is placed in the area of the previous HA filler for injection, whether it’s the cheeks, lips, nose, eyes, etc. Most patients don’t require pretreatment numbing. Any discomfort, bruising, or swelling is typically mild and short-term.

Results may be noticeable within minutes after hyaluronidase injection and continues to work with time. Repeat injections may be necessary to help dissolve all the filler as necessary. Injecting hyaluronidase is not known to permanently dissolve any appreciable naturally occurring HA in your own tissue. In addition, hyaluronidase may be injected at anytime after HA filler treatment, even months after the initial filler injection.

Hyaluronidase primarily works on dissolving HA from aesthetic treatments. It does not directly reduce or remove scar tissue, swelling, and non-HA fillers (ex. collagen, Radiesse, Sculptra).

Lastly, hyaluronidase injection is not exact science. Some or all of the HA filler may be removed with a single hyaluronidase treatment. For those who just want “a little excess HA filler removed” might have all of it dissolved by even a little hyaluronidase. Patients who have had thick HA fillers injection (ex. Voluma®) might need repeated hyaluronidase treatments to have all the filler removed.

You don’t have to live with the results of HA filler if you’re not happy. Lips that are too big, eyes that are too puffy, or cheeks that are lumpy after HA fillers can all be potentially treated with hyaluronidase. An injection with hyaluronidase is relatively easy and works quickly.

Further questions? Ask below or schedule a consultation with Dr. Chaboki.

28 Responses to Removing facial fillers with hyaluronidase injection

  • Leonora Daugaard says:

    Hi, i want a facelift, but i got the Y lift wich is fillers in the jawline.
    I got Y lift in june last year. Is it ok to dissolve fillers the same day of surgery?

    • Houtan Chaboki, M.D. says:

      For patients considering facelift surgery, most plastic surgeons will recommend dissolving fillers several weeks prior to surgery. Ideally before cosmetic surgery, plastic surgeons should evaluate the skin and facial structures without the presence of facial fillers. Thank you for the question!

  • Peggy Wei says:

    I had hyaluronidase over treated and has a skin depression under the eyes, will it back to normal before the hyaluronidase injection? Thank yiu

    • Houtan Chaboki, M.D. says:

      Thank you for reading our blog. Hyaluronidase typically dissolves HA filler that has been placed previously, but may also dissolve HA that is naturally present in the tissue. However, injecting hyaluronidase is not known to permanently dissolve any appreciable naturally occurring HA in the tissue.

  • Peggy Wei says:

    Hi. You mentioned most plastic surgeons will recommend dissolving fillers several weeks prior to facelift surgery. How the surgeon determine how many units of hyaluronidase to use and without dissolve our natural HA? Thank you.

    • Houtan Chaboki, M.D. says:

      The treatment with hyaluronidase is very individualized by plastic surgeons depending on multiple factors. Some treatment factors may include specific filler material, volume of filler material, and previously treated area. Ideally before cosmetic surgery, plastic surgeons should evaluate the face without the presence of facial fillers. However, hyaluronidase may or may not be necessary. Patients should speak with their plastic surgeons to determine if hyaluronidase is appropriate, and how hyaluronidase might be applied.

      Best,
      Dr. Chaboki

  • Peggy Wei says:

    Hi, the skin depression and fat atrophy cause by mixed low dose of kenalog 10 and hyaluronidase injection reversible? Thank you

    • Houtan Chaboki, M.D. says:

      Every patient responds to treatment differently, and each plastic surgeon or dermatologist will modify hyaluronidase treatment. As a result, it’s difficult to determine specific results, such as skin depression. Patients should speak with their plastic surgeons to determine if hyaluronidase is appropriate and how hyaluronidase might be applied.

      Best,
      Dr. Chaboki

    • fad says:

      I’ve had the same , kenlog (triamcinolone ) injection 4 times in my nose to make it thinner , I had hyaluronidase several times , the last one was in the nose lips and chin and all my face was affected I couldn’t leave the house for around 4 days , this product is the worst to be used I really suggest to just leave the filler until it disappear by itself rather than to use hyaluronidase , it has affected my eyes my lashes and everything , It’s been 8 months now and I don’t know what to do I’ve tried to put filler after the dissolving but it doesn’t become as before but looks uglier , I think I’ve ruined my face forever , I really need a help and just want to know if everything is going back or not I look older now more wrinkles that I didn’t have before , my skin is not as before anymore it has been damaged, and easily bruised and whenever I have injury it doesn’t go at all

      • Houtan Chaboki, M.D. says:

        Thank you visiting our website and reading the blog! Injections such as steroid (ex. Kenalog®) or hyaluronidase (ex. Hylenex®, Vitrase®, and Amphadase®) may be injected under physician guidance, as appropriate, for a number of reasons in a cosmetic surgery office. These injections are given in various areas of the face. As patients may react differently, one should speak with their plastic surgeon or dermatologist to help determine appropriate options.

        Best,
        Dr. Chaboki

      • Georgia says:

        How is your face now? Has it gone back to normal after the Hyaluronidase?
        Why do the doctors all say it is safe?

        • Houtan Chaboki, M.D. says:

          Thank you for reading. Hyaluronidase has been used for a very long time and used for years before being used in cosmetic surgery to reverse HA fillers. The decision to inject hyaluronidase, as with any treatment, is mutually determined by patient and physician after review of potential risks, benefits, and alternatives. Patients should review with their plastic surgeon or dermatologist to determine if their particular circumstance is appropriate for hyaluronidase injection.

          Best,
          Dr. Chaboki

  • Paula Rae says:

    I had two hyaluronidase injections for a large hard bump near my smile line. I have had this bump for eight months. Was told by the plastic surgeon that it was injected too deep. I now have a depression where the lump was and I still have some product left. Will this depression be permanent?

    • Houtan Chaboki, M.D. says:

      Thank you for visiting our website and reading the blog. Hyaluronidase typically dissolves HA fillers (ex. Juvederm, Restylane, etc), but may also dissolve HA that is naturally present in the tissue. That being said, injecting hyaluronidase is not known to permanently dissolve any naturally occurring HA in the tissue appreciably. Patients should speak with their plastic surgeon or dermatologist to help determine appropriate options.

      Best,
      Dr. Chaboki

  • Sepideh says:

    Hi i had hyaloronidase injection for 3 time in limited dozes, it means i ruined my tissue?:((and also have another question.rediness and a little bit puffyness under the eye after hyaloronidase is normal? And how long does is it take to remove this sign?

    • Houtan Chaboki, M.D. says:

      Thank you visiting our website and reading the blog. Hyaluronidase may be injected more than once under physician guidance, as appropriate. These injections, similar to other injections, may contribute to redness and swelling. Patients should speak with their plastic surgeon or dermatologist to help determine appropriate options.

      Best,
      Dr. Chaboki

  • Crystal says:

    Aloha Doctor,
    I had undereye filler about 3 months ago and it didn’t come out as I envisioned. My right side of my face is more filled than the other, my undereye now have a blueish half moon that looks sunken in almost. I guess because the filler didn’t make it to the undereye but along the cheek bone making that swollen and uneven. I want to get it removed. Should I remove it or wait it out?

    • Houtan Chaboki, M.D. says:

      Aloha, and thank you for reading our blog!

      The decision to inject hyaluronidase, as with many cosmetic treatments, is mutually determined by patient and physician. Patients should speak with their plastic surgeon or dermatologist to help understand if their particular circumstance is appropriate for hyaluronidase treatment.

      Best,
      Dr. Chaboki

  • Rumy says:

    Hi,

    After several rounds of hyaluronidase on my cheeks I can hardly move my face now. There’s no filler left but my face feels very stiff as if I have thick chewing gum under my skin (sorry I couldn’t come up with better description). I find it difficult to smile or move my right check in particular. The left one is also stiff but it moves ok. I went to neurologist because I was worried I had bell palsy but the doc said no, because only my cheek is affected (not the forehead and the eye) I look as if I had a mild stroke as my lips on the right side are also slightly down. It took about 3 days after my last hyaluronidase injection for my cheek to go stiff and it got worse gradually over the following week. Needless to say I am freaking out.

    Do you have any idea what might have caused this? Is it possible hyaluronidase overdose?’ And if so, will be face recover? I went about 4 times to dissolve the filler but have no idea how much hyaluronidase was put in. The injections were rather deep.

    Thank you to taking the time to read this and I’m looking forward to your reply.

    Best regards,

    • Houtan Chaboki, M.D. says:

      Thank you for reading the blog.

      Whether for lip enhancement, eye bag reduction, or cheek augmentation, every patient responds to filler injections (ex. Restylane®, Juvederm®, Belotero®, etc) and hyaluronidase differently. Each plastic surgeon will modify the treatment according to the needs of each particular patient. Facial injections, similar to any other injections, may contribute to redness and swelling. Hyaluronidase injections are considered very safe and have been used for years for non-cosmetic purposes in medicine before being used in cosmetic surgery to reverse HA fillers. Multiple injections of hyaluronidase may be required to adequately remove the previous filler. Patients should speak with their plastic surgeons to determine appropriate management.

      Best,
      Dr. Chaboki

  • Patricia Heim says:

    Yesterday, I received an injection of wydase to dissolve restylane (from a restylane “cheek lift” I had last April, some of which apparently migrated from the cheek to the under eye area and caused swelling, or what looked like swelling). I noticed the swelling begin to diminish very quickly, yesterday, after the injection andI was so ecstatic, but when I woke up this morning, I saw that there is a noticeable indentation, perhaps at the injection sight, that makes the under eye look distorted and casts undesirable shadows when I look in the mirror. Also, in the area directly under that eye, the wrinkles haven’t yet returned, so it seems there was swelling there that hasn’t responded. Thanks for any help you might have to offer.

    • Houtan Chaboki, M.D. says:

      Thank you for reading the blog.

      There are several brand names of hyaluronidase and each patient may respond to hyaluronidase differently. Swelling can occur both after filler injections and hyaluronidase injections. Multiple injections of hyaluronidase may be required to adequately remove the previous filler, especially for thicker fillers that last a very long time. Each plastic surgeon will modify the treatment according to the needs of each particular patient. Patients should speak with their plastic surgeons to determine appropriate management.

      Best,
      Dr. Chaboki

  • Fad says:

    I’ve had hyalourindase injection many times the last one was in my nose and lips and chin
    I’ve put kenalog in my nose before for 4 times to get it smaller since I had nose job and there is a gore tex implant

    Once I had the hyalourindase injection in my nose my full face has been affected and I had swelling all over the fae and I couldn’t leave the house for 4 days , after 3 weeks my face started to have atrophy ( my lips, my eyes, my cheeks , chin ) there was a strange depression , I thought that with Hyalourindase I’m just going to get my normal face back but unfortunately it made it worse (looks ugly)
    I really don’t advise any to use hyalourindase but just to wait for the filler to be gone with itself
    As also it has affected my skin , more wrinkles , discoloration , and also it can easily bruised and takes long time to heal , I really depressed and don’t know what to do , I tried to put filler again but its doesn’t be as before I think I have ruin my face forever

    • Houtan Chaboki, M.D. says:

      We’re glad you’ve found this blog informative. Injections of steroid and/or hyaluronidase of the face, similar to other cosmetic treatments (ex. facelift or eyelid surgery), will vary among patients and plastic surgeons. Speaking with you plastic surgeon or dermatologist can help determine appropriate options for each patient.

      Best,
      Dr. Chaboki

    • Houtan Chaboki, M.D. says:

      Thank you for your question and reading the blog.

      We don’t have an exact answer as the body is a dynamic system. There is some evidence that external hyaluronidase may induce the synthesis of HA. In other words, degrading the body’s own HA by injection of hyaluronidase is followed by new synthesis of HA. However, each patient is unique and there might be a relatively temporary deficit of HA for a brief time. Speaking with a plastic surgeon or dermatologist can help determine appropriate options for each patient.

      Best,
      Dr. Chaboki

  • Amal says:

    Dear dr
    I have had cheek augmentation with Rystaline Perlane
    However, I don’t like the result as there are multiple lumps and its unequal distribution
    I have had 3 sessions of treatment with hydrolinase yet, its minimally reduced
    I would like to hear your thought about it

    • Houtan Chaboki, M.D. says:

      Thank you for reading our website. Restylane® and Perlane® are made of hyaluronic acid gel, which typically responds to hyaluronidase injections. Multiple treatments may be required for some patients, especially for those who received high volume filler injections, frequent filler injections, or received very thick filler injections. Every patient is unique and treatments will vary. Speaking with an expert injector can help determine appropriate options for each person.

      Best,
      Dr. Chaboki

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    Houtan Chaboki, M.D.