12 Mar Dissolving Fillers in Singapore: Hyaluronidase and Risks

Dissolving Fillers with Hyaluronidase: Results, Risks and Recovery

Hyaluronidase is an enzyme that breaks down hyaluronic acid, or HA, which is used in many dermal fillers¹. Doctors use it to reduce unwanted HA filler and manage selected complications, although removing the material does not guarantee reversal of every complication². Before you consider removing your dermal fillers, let this guide take you through the indications, process and limitation of hyaluronidase treatments for filler removal.

What hyaluronidase dissolves. Hyaluronidase is used for hyaluronic acid filler, while other filler materials need a different assessment and cannot be dissolved in the same way

What does hyaluronidase dissolve?

Hyaluronidase breaks the chemical bonds within HA chains, allowing the gel to degrade¹. Hyaluronidase acts specifically on HA fillers, and not all other dermal fillers, so calcium hydroxylapatite, poly L lactic acid and polymethylmethacrylate fillers cannot be dissolved with the same enzyme².

If you’re considering filler removal, please bring along information about the filler name, volume used and timelines if possible. My clinic’s overview of dermal fillers explains the differences between materials and why identifying the preparation matters.

When do dermal fillers require reviews?

Why might someone consider dissolving filler?

Filler removal is commonly done for emergencies, when the filler has caused vessel occlusion or if the derml filler has resulted in infection or inflammation that do not respond to conservative treatment with medications.

Fillers may also be removed for cosmetic reasons. These presentations include unwanted fullness, asymmetry, misplaced HA and visible or palpable deposits². Superficial HA can also cause a blue grey appearance, commonly called the Tyndall effect, particularly beneath the eyes².  My article on excessive filler and unwanted changes in facial proportions discusses appearance concerns in more detail. 

Seek urgent help if you notice these symptoms: worsening pain, pale or dusky skin, mottled colour changes and visual symptoms require urgent medical attention

When is a filler injection an emergency complication?

Increasing pain or skin that becomes unusually pale, dusky or mottled requires immediate medical assessment, because these changes can indicate interrupted blood supply⁴. 

Sudden blurred vision, loss of vision or new neurological symptoms after facial filler require emergency care⁵. 

How filler dissolving is done. A typical appointment involves assessment, treatment planning, careful injection of hyaluronidase and review of the response

How are filler dissolving injections performed?

The appointment begins with a treatment history, examination and discussion of the intended change, alternatives and risks³. The skin is cleansed, and measures to reduce injection discomfort may be discussed before proceeding³.

The doctor injects hyaluronidase into the area containing the HA deposit². The amount and placement depend on the material being treated, its location and the reason for dissolving².

Ask which preparation will be used, particularly when its source is relevant to your medical history or personal preferences. Published literature describes both animal sourced and recombinant human hyaluronidase preparations².

Recovery after dissolving fillers can include early swelling or bruising, followed by reassessment as the treated area settles over the next one to two weeks

How quickly does hyaluronidase work?

Hyaluronidase can begin acting promptly, but the visible response depends on the filler’s properties and the amount of dermal filler present¹. 

Guidance for elective dissolving recommends reassessment after approximately forty eight hours, although procedural swelling may take longer to subside⁹. 

 

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Does hyaluronidase affect natural HA or cause hollowing?

Hyaluronidase can break down naturally occurring HA as well as injected HA filler⁹. This may also result in hollowing or skin laxity¹¹. A 2024 retrospective study examined 157 treated eye regions in 90 patients and recorded adverse appearance changes, including hollowing, after dissolving¹¹. 

What are the side effects of hyaluronidase?

Local reactions after hyaluronidase injections can include swelling, redness, itching, bruising and discomfort³. Allergic reactions, including serious reactions, have also been reported⁹.

If you have previous reactions to hyaluronidase and significant bee or wasp sting allergies, please inform your doctor about thes allergies which can affect the risk assessment⁹.

Does an allergy test guarantee safety of hyaluronidase?

An allergy assessment may be appropriate before elective treatment⁹. However, a negative skin test does not exccllude delayed reactions¹. If an emergency such as vascular occlusion has occured, filler removal should not be delayed for the sake of allergy skin testing². 

What should you expect after filler dissolving with hyaluronidase?

Post procedure, common reactions include swelling and bruising which can temporarily visual assessment³. These reactions should subside in days, with hyaluronidase simultaneously breakind down the HA filler.

When can filler be injected again?

Expert guidance recommends waiting at least two weeks after elective dissolving, and longer when swelling persists, before considering another filler treatment⁹.

References

1. Jung H. Hyaluronidase: An overview of its properties, applications, and side effects. Archives of Plastic Surgery. 2020;47(4):297 to 300.
2. Kroumpouzos G, Treacy P. Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations. JMIR Dermatology. 2024;7:e50403.
3. Urdiales Gálvez F, Escoda Delgado N, Figueiredo V, et al. Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations. Aesthetic Plastic Surgery. 2018;42:498 to 510.
4. Murray G, Convery C, Walker L, Davies E. Guideline for the Management of Hyaluronic Acid Filler Induced Vascular Occlusion. Journal of Clinical and Aesthetic Dermatology. 2021;14(5):E61 to E69.
5. Sansome S, Clague M, Convery C, et al. Consensus Guidelines for the Management of Tissue Filler Induced Vision Loss in the United Kingdom. Aesthetic Surgery Journal. 2026;46(5):563 to 568.
6. Singapore Civil Defence Force. Emergency Medical Services.
7. Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2023;84:656 to 669.
8. Woodward J, Cox SE, Kato K, et al. Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization. Aesthetic Surgery Journal Open Forum. 2023;5:ojad016.
9. Murray G, Convery C, Walker L, Davies E. Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High Dose Protocol. Journal of Clinical and Aesthetic Dermatology. 2021;14(8):E69 to E75.
10. Alam M, Hughart R, Geisler A, et al. Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules: A Randomized Clinical Trial. JAMA Dermatology. 2018;154(7):765 to 772.
11. Wilde CL, Jiang K, Lee S, Ezra DG. The Posthyaluronidase Syndrome: Dosing Strategies for Hyaluronidase in the Dissolving of Facial Filler and Independent Predictors of Poor Outcomes. Plastic and Reconstructive Surgery Global Open. 2024;12(4):e5765.