Hyaluronidase is an enzyme that breaks down hyaluronic acid. It can therefore be injected into an area containing hyaluronic acid dermal filler to reduce or remove filler when clinically appropriate.

Filler dissolving may be considered for:

• Unwanted or excessive filler 
• Filler migration 
• Asymmetry or irregularity associated with previous filler 
• Persistent lumps where dissolving is appropriate 
• Returning closer to your pre-filler appearance 
• Preparing an area for reassessment before considering further treatment 

Hyaluronidase only works on hyaluronic acid-based fillers. If you don't know what product was previously injected, please tell Dr Jackie during your consultation. 

Consultation
Dr Jackie will assess the area, discuss when and where your previous filler was placed and, where possible, what product was used. Sometimes the best approach is to dissolve only part of the existing filler. In other situations, more extensive dissolving may be appropriate.

Treatment
If treatment is appropriate, hyaluronidase is injected into the area containing the unwanted hyaluronic acid filler. The amount and placement required vary considerably according to the filler present and the reason for dissolving.

Downtime
Temporary redness, swelling, tenderness and bruising can occur following treatment.

Importantly, swelling immediately afterwards can temporarily make it difficult to judge the result, so the area needs time to settle before deciding whether further treatment is required.

Results
Hyaluronidase begins acting quickly, but the cosmetic result shouldn't necessarily be judged immediately. Once swelling has settled, Dr Jackie can reassess the area and determine whether sufficient filler has been dissolved or whether further treatment would be useful.

Not completely. Hyaluronidase cannot simply identify the particular piece of filler that you dislike. Once injected, it can affect hyaluronic acid filler within the treated area. For that reason, dissolving should be approached thoughtfully rather than assuming that one small unwanted area can always be removed without affecting surrounding filler.

Your appearance may also change as the filler is removed and the tissues settle. Dr Jackie will discuss what can realistically be achieved before treatment.

Allergic reactions to hyaluronidase are uncommon but can occur and, rarely, may be serious. Your medical and allergy history will therefore be reviewed carefully before elective treatment.

Particular attention will be paid to previous reactions to hyaluronidase and relevant allergy history, including significant reactions to bee or wasp stings, because there can be cross-reactivity between some components of venom and hyaluronidase.

Dr Jackie will discuss intradermal testing  before elective treatment.

A negative test cannot guarantee that an allergic reaction will not subsequently occur, so appropriate precautions remain important whenever hyaluronidase is administered.

The information on this page relates primarily to planned cosmetic correction of existing filler.

Hyaluronidase also has an important role in the emergency management of some complications of hyaluronic acid filler, particularly suspected vascular occlusion.

That is a very different situation. Emergency treatment should not be delayed in order to perform routine elective testing.

If you have recently had dermal filler and develop severe or increasing pain, unusual blanching or discolouration of the skin, or any visual symptoms, seek urgent advice from your treating practitioner.

Visual disturbance following dermal filler is a medical emergency and requires immediate emergency assessment.

Sometimes dissolving is the end of the process.

If you are considering having filler replaced, it is usually better to allow the area to settle and then reassess your natural anatomy before deciding whether further treatment would actually improve the result.

Dr Jackie can then discuss whether:

• No further treatment is needed 
• A small amount of filler would be appropriate 
• A different treatment strategy would produce a better result 

There is no obligation to refill an area simply because filler has been dissolved.

 • Doctor-led assessment

 • Careful correction

 • Realistic expectations

 • No automatic refilling

Filler correction isn't simply about injecting hyaluronidase. Understanding what has been injected, where it sits, what is causing the appearance you dislike and what you hope to achieve is an important part of deciding how to proceed. The aim is to restore balance while avoiding unnecessary cycles of dissolving and refilling.