Elizabeth, 26, had been waiting years to enhance her lips.
It was 2019 and Instagram lips were It.
During her first appointment, she purchased one syringe of Juvederm Volbella.
Henrik Sorensen
I definitely had to be persuaded, she says.
But the NP was like, If you dont like it, itll go away in six months.
I even joined one of those hyaluronidasegroups.
Olvia, before (left) and after (right) Dr. Frank dissolved her lip filler and gave her a lip flip. “The thing with filler is that you always want more. After dissolving, my mouth wasn’t as heavy. I am very happy with my lips now,” says Olivia. Photos courtesy of Dr. Frank.
(More on that soon.)
Ultrasound enables providers to see below the skin and dissolve filler particles more precisely.
In this story:
Is dissolver the new filler?
Board-certified dermatologistPaul Jarrod Frank, MD, sees his fair share offiller fatiguein New York City.
At least two patients a day will come in specifically for reversal, he says.
I go through bottles of Vitrase [hyaluronidase] a day in my office.
Its not a once-in-a-blue-moon, youre-looking-for-it-in-the-back-of-the-fridge punch in of thing.
Whos dissolving their filler and why?
But dissolver isnt the exclusive domain of the overdone.
Olivia, 29, began getting her lips filled after graduating from college.
Instead, he recommended an all-out reversal.
The thing with filler is that you always want more.
After dissolving, my mouth wasnt as heavy.
I am very happy with my lips now, says Olivia.
Photos courtesy of Dr. Frank.
Theyd rather get [lower eyelid] surgery and just live their lives.
Not every case of filler burnout somersaults into getting surgery.
Once free from filler, plenty of folks choose to embrace their natural proportions.
She does this by defining the major support buttresses of the face the cheekbones, jawline, and chin.
What exactly is hyaluronidase?
No matter the accelerant, interest in dissolver has intensified over the past few years, says Dr. Talei.
So has the confusion that surrounds it, he adds, fueled in part by the aforementioned hyaluronidaseforums.
For this reason, hyaluronidase can be difficult to control when harnessed as a filler eraser.
This is not a spot treatment, Dr. Cabin notes.
That said, when targeting pinpoint blips, doctors usually inject the solution with a needle for precision.
For more widespread coverage, they often opt for a cannula.
And remember, both hyaluronic acid and hyaluronidase exist naturally in the body.
Is hyaluronidase safe?
What are the side effects?
When used judiciously, hyaluronidase is considered to be safe and vital in cases of vascular occlusion.
Anotherstudyestimates that it takes the body only 15 to 20 hours to restore lost hyaluronic acid.
Dr. Frank is equally unconvinced that hyaluronidase is deleterious to the skin in a forever sort of way.
I’ve injected thousands of units at a time and I’ve never seen any detriment.
So, how to explain the lasting deflation and defects that some claim to experience post-dissolver?
Theyre also unaware of age-related changes that have occurred while their filler has been in place.
Dissolver, by merely doing its job, can unmask a new reality.
Once dissolved, filler-induced tissue damage can also come to light.
They realize they now have loose, saggy skin, says Dr. Frank.
But that aint from the hyaluronidase its from you overfill[ing] your face for years.
This is not to say that hyaluronidase operates without leaving a trace.
Some of the doctors we interview have witnessed certain dissolver drawbacks.
We definitely see crepey, deflated skin from too much hyaluronidase, says Dr. Weiser.
But we typically see it rebound within a few days of hyaluronidase injection.
In her experience, this helps to maintain the integrity of the skin while boosting the healing process.
Dr. Talei insists, however, that dissolver is not dangerous.
When handled properly, its a fantastic tool to have when we need to get rid of filler.
Healthy tissues begin to rehydrate within a week, he says, and ultimately snap back, no problem.
What is it like to dissolve your filler with hyaluronidase?
Dr. Weiser, for instance, has her reversal routine down pat.
For reference, on a very overfilled face, she injects 100 to 200 units, max.
When tweaking smaller areas or less extreme scenarios, shell use closer to 20 to 40 units, selectively.
If she is finessing filler rather than fully removing it, a patient may require less.
You cant really see whats what.
If someone comes to me and says, Oh, God, I went to this med-spa.
I had my eyes done for the first time.
(Every patient is different, of course.
Olivia says she felt only mild stinging and experienced zero bruising.
After dissolving, my mouth wasnt as heavy, she says.
I didnt realize how much weight was there.)
Moreover, people are sometimes surprised to learn that they cant refill on the heels of dissolving.
I may have to send them for a blepharoplasty [upper and/or lower eyelid surgery].
I may have to do CO2 laser resurfacing [to tighten the skin].
Or I may have to do a bit of both.
How much does it cost to dissolve filler?
Dissolving generally starts around $400, but can climb into the thousands.
Dosing is largely determined by the amount of filler in play and the areas being treated.
The technique originally used to place the filler can also influence the ease with which it dissolves.
Also worth noting: Certain types of filler degrade faster than others.
In his experience, he adds, some brands of filler are much easier to melt than others.
Every intervention is going to cause a butterfly effect in the face, Dr. Devgan says.
Theres no way to leave the universe unperturbed.
So the word “reversal” in this context is really a misnomer.
Read more on injectables:
Watch as a dermatologist explains how fillers work:
