Dissolving filler: how hyaluronidase works, when to use it, and what to expect

One of the meaningful advantages of hyaluronic acid (HA) filler over most other aesthetic treatments is reversibility. HA filler can be dissolved with an enzyme called hyaluronidase — quickly and effectively when needed. Here's everything you need to know about the process.

What hyaluronidase is

Hyaluronidase (brand names: Hylenex, Vitrase) is a purified enzyme that breaks down hyaluronic acid by cleaving its molecular bonds. When injected into or near HA filler, it rapidly degrades the gel.

The dissolving process is essentially the reverse of filling: the enzyme breaks the HA chains into fragments that are then cleared by your body's normal metabolic processes.

What hyaluronidase dissolves (and what it doesn't)

Dissolves:
Any HA filler (Juvederm, Restylane, Belotero, Voluma, Volux, Sculptra is NOT HA, Radiesse is NOT HA — see below)
Both intentional placements and misplaced product

Does NOT dissolve:
Sculptra (PLLA): No enzyme equivalent
Radiesse (CaHA): No enzyme equivalent
Silicone: Cannot be reversed
Fat (from fat transfer): Not applicable
Your natural hyaluronic acid: Hyaluronidase dissolves HA indiscriminately — including some of your own tissue HA — which is why temporary changes in the treated area are expected after dissolution

When filler dissolution is indicated

Vascular occlusion (medical emergency): The most urgent indication. If injected filler blocks a blood vessel, immediate hyaluronidase injection is required to restore circulation and prevent tissue necrosis. This is why qualified injectors must have hyaluronidase on hand at all times.

Tyndall effect: Blue-grey discoloration from HA placed too superficially (often under the eyes). Hyaluronidase resolves this by degrading the filler.

Lumps or nodules: Poorly distributed or encapsulated filler that hasn't responded to massage.

Migration: Filler that has shifted from the original injection site.

Overfill or patient dissatisfaction: Patient is unhappy with the amount of volume or the aesthetic result.

Asymmetry: Uneven results that don't resolve with swelling.

What the dissolution process is like

Session: Hyaluronidase is injected directly into the area containing filler. The provider may inject at multiple points across the area. Most patients experience mild stinging — similar to other injections.

How fast does it work: Dissolution begins within minutes and is largely complete within 24–48 hours. Some residual swelling or redness may last a few days.

Post-treatment: The treated area may appear hollow or deflated as the filler dissolves — including (temporarily) the underlying tissue HA. This hollowness typically resolves over 2–4 weeks as your body's natural HA redistributes.

Can you refill immediately? Most providers recommend waiting 2–4 weeks before re-injecting into a dissolved area to allow full clearance and proper assessment. For vascular occlusion emergencies, high-dose hyaluronidase is administered immediately regardless of future re-fill timing.

Does hyaluronidase affect natural tissue?

Yes — temporarily. Hyaluronidase does not distinguish between filler HA and your own natural HA. In the treated area, some natural HA is also degraded. This is why the area may look more hollow than before original treatment. Your body replenishes natural HA over 2–4 weeks.

There is no permanent structural damage from properly administered hyaluronidase. The enzyme is quickly inactivated and the tissue recovers.

Allergy risk

Hyaluronidase carries a small risk of allergic reaction — more commonly in patients with known bee sting allergies (bee venom contains hyaluronidase). Providers should ask about bee sting allergy before administering. Skin testing before emergency use is not practical; for elective dissolution, some providers perform a test dose.

Cost

| Scenario | Typical cost |
|---|---|
| Small area dissolution (tear trough, one region) | $200–$600 |
| Multiple area dissolution | $400–$1,200 |
| Emergency vascular occlusion treatment | Often provided at no charge by the treating injector |

Dissolution is generally less expensive than the original filling procedure. Some providers offer a single dissolution session at no or reduced cost if you're their patient returning due to a complication or dissatisfaction.

When to dissolve vs. wait

Not every imperfect filler result needs immediate dissolution:

Wait for swelling to resolve (2 weeks): Lumps, asymmetry, and firmness from the first week often improve significantly. Evaluating before 2 weeks leads to unnecessary dissolution of what would have been a fine result.

Massage first: Firm nodules can sometimes be broken up with careful massage. Your provider should guide technique — aggressive massage in high-risk areas like tear troughs is not recommended without guidance.

Dissolve promptly for:
Any sign of vascular compromise (blanching, pain, mottling, visual changes) — this is an emergency
Tyndall effect — waiting makes it worse
Clear overfill that causes functional concern (can't fully close eye, visible filler in motion)

Practical notes for patients considering dissolution

Go back to the original provider first if possible — they understand the product used, the amount injected, and the placement
If you had filler elsewhere and are unhappy, a different qualified injector can still dissolve it — the process doesn't require knowledge of the original injector's technique
Inform the provider of all filler you've had — in all areas and from all sources — so they have a complete picture before dissolving
You can re-fill after dissolution — either with a different product, a different amount, or a different technique

Questions to ask before dissolving

Can you tell whether this is HA filler (which can be dissolved) or a non-HA product?
How many sessions of hyaluronidase do you estimate this will take?
How long after dissolution should I wait before re-filling?
Will dissolution bring me back to my pre-filler baseline, or will the area look worse before it looks natural?
If I dissolve, what would you do differently if I want to re-fill?

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