Comedian Amy Schumer getting her face numbed before removing her cheek fillers

 

What happens if you had dermal fillers injected but you don’t like what you see? For a majority of facial fillers, you could wait it out for the results of your dermal fillers to fade away. But for someone who does not like the results of their facial fillers, or worse, suffered complications of dermal filler injections, waiting could feel like an eternity.

 

Thankfully, if you find yourself in any of these situations, there’s a consolation (and lifesaver): hyaluronidase. This drug can dissolve dermal fillers to undo the effects and complications of facial fillers. Actress Courtney Cox and more recently, comedian Amy Schumer have shared that they chose to remove their dermal fillers via this route as they did not like the results of their facial fillers.

 

This review will explain everything you need to know about removing facial fillers with hyaluronidase (aka hyalase). For anyone considering facial fillers to enhance their looks; this blogpost is highly relevant for you too.

 

What are facial fillers?

 

Dermal fillers are soft gels that are injected into the face to fill lines (e.g. laugh lines/ nasolabial folds) and static wrinkles; sculpt the face (e.g. nose and chin fillers); and treat sagging and volume loss (e.g. cheek fillers).

   

Actress Courtney Cox has openly shared about dissolving away her facial filler

 

Why are facial fillers removed?

 

Non-surgical removal of facial fillers with hyaluronidase is offered when the results of dermal filler injections are not satisfactory. Some examples are:

• Excessive fillers injected and overfilled faces. You can see classic examples of pillow faces, sunset eyes and more in this blogpost Fillers Gone Wrong: Tell Tale Signs of Too Much Filler Injections.

• Results of dermal filler injections were not satisfying. When the facial fillers injected do not follow ideal facial proportions; the results can be unnatural. For example, cheeks fillers can risk making a person’s face look wide. Removing the facial filler injected may be needed in such instances- just like Amy Schumer and Courtney Cox. You can learn more about cheek fillers in Getting Cheeky: A Guide to Cheek Fillers.

• Dermal fillers can also cause lumps or discolouration in the skin. A classic example is called the Tyndall effect with tear trough fillers for dark eye circles or eyebags. Superficial placement of dermal filler in the tear trough area causes a blue discolouration under the eyes. Learn more in Fillers for Dark Eye Circles and How to Treat Eye Bags without Surgery: Tear Trough Fillers.

• Infections involving dermal fillers are very uncommon. However if it does arise, one of the treatment prongs is to dissolve away the dermal filler.

• Perhaps the most pressing reason for removal of dermal fillers is when complications such as vascular necrosis or blindness occur. Dermal fillers can potentially obstruct vessels, which compromises blood supply to surrounding tissues. If the blood vessel occluded also supplies the eye, blindness can also occur. This risk is highest with nose fillers, so my preference for non-surgical nose enhancement is a nose threadlift. You can read about this safer alternative in Hiko Nose Threadlift: All You Need to Know.

 

Hyaluronidase disintegrates hyaluronic acid fillers. Image credit: Buhren et al. 

What is hyaluronidase?

 

Hyaluronidase is an enzyme that degrades hyaluronic acid by breaking up intramolecular cross links. This enzyme is naturally occurring in our organs (e.g. skin, eyes, liver, kidneys) and body fluids (e.g. blood, tears and semen)

 

For the removal of hyaluronic acid fillers, hyaluronidase enzyemes only dissolve hyaluronic acid dermal fillers. Dermal fillers that contain Polycaprolactone (Ellanse), Poly-L-Lactic Acid (aka Sculptra) and Calcium hydroxylapatite (Radiesse) cannot be broken down by hyalase. These types of dermal fillers do not have an ‘antidote’ to reverse the outcome of dermal filler injection.

 

Hyaluronidase that is used for medical treatments including non-surgical removal of dermal fillers is obtained from animal sources (cows and pigs).

 

Hyaluronidase cleaves the cross links within hyaluronic acid molecules in dermal fillers. Image credit: Weber et al. 

 

How is non-surgical filler removal with hyaluronidase enzymes performed? 

 

In Singapore, hyaluronidase injections are performed by doctors in sterile clinic settings. Patients who come to my practice asking for second opinions of their dermal filler injections or non-surgical filler removal; a detailed assessment and evaluation of the patient is first required before proceeding with hyalase injection.

 

After the expected results and side effects of hyaluronidase are explained (see below), the process of non-surgical removal is commenced. In my clinic in Singapore, the sites of hyaluronidase injection are numbed before proceeding.

 

Diluted hyaluronidase enzymes are injected into and surrounding the tissues where the dermal filler has been previously injected. The effects of non-surgical removal of dermal fillers with hyaluronidase can been seen within minutes.

 

What should I expect from non-surgical removal of dermal fillers with hyaluronidase injection?

 

Once injected, hyaluronidase enzymes have immediate effects. The dermal filler is usually partially removed in an hour. However, due to swelling from the injection, it can take at least a few days to see full results of hyalase enzymes injection. In some instances, repeated injections of hyalase enzymes may be required to completely remove the dermal filler.

 

 Learn about the different types of dermal fillers available in Singapore in Botox VS Fillers: What Are the Differences?

How successful or effective is non-surgical removal with hyaluronidase injections?

 

Non-surgical removal of dermal fillers with hyaluronidase enzymes only works for fillers that contain hyaluronic acid. Dermal fillers that contain other materials cannot be degraded by hyalase enzymes.

 

Factors such as amount of dermal fillers injected, concentration of hyaluronic acid in the dermal fillers and amount of cross linking in the fillers will affect the outcomes of hyalase injections. For dermal fillers injected in larger amounts or higher concentrations of hyaluronic acid, a larger amount of hyaluronidase enzymes is required to remove the dermal filler. Dermal fillers that contain extensive cross linking require a longer time to be degraded.

 

Would you like to watch how dermal fillers get dissolved by hyaluronidase? Head over to my Instagram @drrachelho to see this experiment I filmed in the clinic 🙂

 

Will my natural hyaluronic acid also be dissolved away by hyaluronidase?

 

Yes, hyaluronidase enzymes can also break down naturally occurring hyaluronic acid in the body. The results of the breakdown with hyalase can be hard to predict. Loss of volume and skin laxity may occur. Hence, small doses and precise injections of hyaluronidase enzymes is used to minimise this side effect. Hyaluronidase, however, does not dissolve or break down tissues or protein structures in the skin.

 

What are the side effects of hyaluronidase injections?

 

Some of the expected effects of non-surgical dermal filler removal with hyaluronidase injections include swelling, itching and allergic reactions. If you have allergies to bee stings or bovine collagen, cross reactions can occur with hyaluronidase and cause allergic reactions.

   

 

When can I get fillers injected again after hyaluronidase injections?

 

After non-surgical filler removal with hyalase, there can be volume loss and asymmetry if the dermal filler on the contralateral side of the face is not removed. It is possible to correct the asymmetry and volume loss with dermal fillers once again.

 

My preference is to allow enough time for the dermal fillers to be completely removed and for any swelling to subside first. I recommend waiting 2 weeks after hyalase has been injected before proceeding with dermal filler injections again.

 

What is the cost of filler removal with hyaluronidase injections in Singapore?

 

Please submit your request through the enquiry form on this website or contact my clinic directly.

 

References:

1. Hyaluronidase: An overview of its properties, applications, and side effects. Jung. Arch Plast Surg. 2020 Jul; 47(4): 297–300.

2. This month’s guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4). King et al. J Clin Aesthet Dermatol. 2018 Jun; 11(6): E61–E68.

3. Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Buhren et al. Eur J Med Res. 2016; 21: 5.

4. Clinical Applications of Hyaluronidase. Weber et al. Therapeutic Enzymes: Function and Clinical Implications pp 255-277.