How is dermal filler dissolved?
Hyaluronidase is an enzyme that breaks down hyaluronic acid (HA). It can therefore be used to dissolve hyaluronic acid-based dermal fillers. Hyaluronidase traditionally comes in powder form and is reconstituted with saline to form a water-like solution. This is then injected into the area where the unwanted filler is, where it then takes its action. The hyaluronidase causes some temporary swelling and may cause bruising. It starts breaking down HA filler straight away and so you can expect to start seeing results on the day of the treatment with the maximum result visible within 48 hours in most people. Injectable hyaluronidase is capable of passing through multiple tissue planes and will dissolve all HA filler that is present. It is therefore suitable for use when the goal is total filler dissolution.
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Hyaluronidase now comes in another form; a cream called topilase that can be applied directly to the skin. Topilase was initially developed for dissolving excess, superficially placed placed filler in the tear trough region. It can, however, be used to treat other regions in which filler is superficially placed, such as the lips. In this instance it is useful for targeting pockets of unwanted filler, such as lumps, whilst leaving the majority of the filler unaffected. Multiple treatments may be required to achieve the desired effect. A top-up appointment will therefore be arranged if topilase is deemed to be the most appropriate treatment option.
The process
Before treatment
At your consultation, your face will be assessed and Dr Horlick will recommend a treatment plan based on this. A consent form will be completed and before photos taken. A patch test will be required when using injectable hyaluronidase to rule out the presence of an allergy to the agent, which would contraindicate its use.
During treatment
If injecting hyaluronidase, a local anaesthetic cream will be applied to the treatment area to numb it for 5-10 minutes before commencing. The product will then be dispersed throughout the area containing the unwanted filler. If topilase is used, the cream will be rubbed into the affected area for 2 minutes and then any residual wiped away.
After treatment
You will be advised of the aftercare instructions and your next appointment will be booked if applicable. It is normal to experience temporary swelling, bruising and mild discomfort following injectable hyaluronidase treatment. Ice packs and anti-histamines can help to minimise this.
Results
You can expect to start seeing your results on the day of or the day after the treatment, and they will continue to improve over a 48hr period.
Hyaluronidase side effects
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Swelling
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Bruising
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Stinging/burning
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Allergy- a small subset of people develop severe allergies to hyaluronidase. The treatment is contraindicated in these people. A patch test is done prior to the treatment to ensure a severe allergy is not present.
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Dissolving patient's own HA- Hyaluronidase will dissolve some of the patient's own HA, meaning that the treatment area may initially look smaller than it did prior to the filler. This is temporary as the body will regenerate the HA over time.