Dissolving Old Fillers
Dermal fillers known in various brand names such as Juvederm, Restylane, Teosyal, Stylage, etc. are dissolvable by nature. Hyaluronidase is a soluble protein enzyme that is typically used to break down the hyaluronic acid found in dermal filler. The solution works by breaking up the bonds that hold the HA molecules together and encourages the body to reabsorb those molecules in a natural process. It accomplishes this by increasing tissue permeability, splitting the molecular bonds holding the hyaluronic acid together and promoting the natural cellular processes responsible for its diffusion. Dermal fillers injecting procedure isn’t always perfect. There are always risks related to anatomy and how filler will behave in the tissues. There might be foreseeable problems that can be adjusted with appropriate technique, placement and product, however some are beyond our control and this is when mild dissolving or emergency dissolving may be required. The reason of dermal filler dissolving might be due to overfilled lips or other areas, lumps and unevenness of dermal filler result, allergic reaction (prolonged swelling), infection, visible asymmetry or late reaction (swollen lumps at the filler areas which are usually seen at tear through areas even a few months after the filler has been injected). As we go through the process of dissolving the chosen area with you, we can assess your body’s and skin’s response and advise further on the process based on your outcomes. The degree of further treatment will depend upon indication, risks versus benefits and side effects from treatment. BEFORE & AFTER TREATMENT STEPS Step 1 CONSULTATION You will have an initial consultation and skin assessment detailing your past medical and cosmetic history with Nurse Maya. By analyzing your skin and addressing your skin concerns, Nurse Maya will advise the most suitable treatment for you. Nurse Maya will determine the areas that need to be dissolved and explain the procedure, the importance of the patch test, risks and after dissolving skin care plan. Since our appointment times are generous, you can be certain that you will receive the professional advice on the most suitable treatment options for you. Receive your treatment in a relaxing clinical environment Enjoy the ‘me’ time as we take you through each treatment stage Targeted protocols give the best results for your skin Step 2 DURING YOUR TREATMENT Nurse Maya will begin by obtaining a consent and taking photographs/ video and discuss with you about your facial anatomy and what can be achieved and expected. As there is a small chance of allergic reaction of Hyaluronidase enzyme, a patch test by injecting a small amount of the enzyme at one of your arms is required to eliminate risk of the allergic reaction. You will be requested to wait 30 minutes at the clinic to see the result of the patch test. The signs of allergic reaction are swelling, rash and redness at the injection site. If there is no sign of allergy, the Hyaluronidase will be injected to the chosen areas. The procedure is mildly painful thanks to Lidocaine (a numbing agent) applied topically on the treated area. We also provide our patients with a custom-made proprietary vibratory pain relief device. Talk through any skin concerns and your treatment goals Identify the best treatment options to achieve desired results Step-by-step information about your treatment Step 3 AFTER THE TREATMENT Once your dermal filler dissolving procedure is complete, Nurse Maya will apply a medical ointment on the treated area. After the dermal filler dissolving treatment there might be redness, swelling or tenderness in the treated area. This is a normal result of the injections and will generally disappear within a few days. Bruising is a common and expected side effect with any filler dissolving treatment. It will not affect your end result. Please plan your treatments accordingly and avoid booking treatments close to big events such as wedding. To reduce the possibility of bruising it is important that clients adhere to the aftercare regime. Please avoid any medications containing NSAIDs, aspirin, vitamin E and ginseng for the week prior and week following a treatment unless medically necessary. In cases, where the use of these medicines is for medical purposes please discuss with your GP prior to stopping any treatment. Immediate recovery Results are visible straight away Benefit from more defined, younger looking face FREQUENTLY ASKED QUESTIONS When the dermal fillers should be dissolved? Product Migration Filler migration is the movement of a dermal filler from its injection site to another area of least resistance where it can comfortably settle. While it is possible for fillers to migrate, it can still be avoided by choosing a qualified injector such as Injector Maya. Some clients’ tissues may have more laxity which results in less support in keeping a filler in one place. Moreover, the dermal filler is soft and moveable for the first 48 hours post procedure, which may cause some compression of filler around areas of higher muscular contraction or if a patient swells significantly after treatment, this can also cause some compression or migration of product. Lumps & Bumps The lumps and bumps usually appear in the trough and lips. The skin around the tear trough area is so thin and unforgiving here and anatomically it is quite unique and more complex. The lips because of the high muscular function the area, and tissue differences. In other areas of the face such as the chin and cheek bone, we are almost trying to create small “lump or bumps” referred to as boluses, to help lift the tissue and create structure. Here we try to ensure they are smooth and consistent, however we don’t want to over massage these areas, as we would lose the lifting or volumizing effect that was initially intended with the dermal filler injection. Emergency Reversal An emergency reversal happens when filler in unintentionally injected into a blood vessel or causes its compression. Dermal filler in a blood vessel will cause a blockage and can cease blood flow and diffusion of necessary oxygen to the tissues. When the tissues don’t have oxygen supply they start to die (tissue necrosis). As experienced injector, Injector Maya is aware of the signs and symptoms of a blockage and will reverse this on the spot if seen. However, at times the vessel doesn’t fully block, or these signs aren’t seen right away. After every dermal filler procedure, Injector Maya educates her patients on what to look for in the consultation and follows up with a safety check 24-48 hours post treatment. If a patient is presenting with signs of a blockage, the client will be advised to immediately return to clinic to assess in person and if a blockage is confirmed we will start the dissolving process, which again can take multiple sessions until we are restore blood flow and circulation to vessels and tissues. Will the filler be dissolved completely in one session? Depending on the type of Hyaluronic acid filler, some of them need more than one session to dissolve. Particularly the large molecule filler for cheek, chin or jaw lines. We always review our patients after two week and top up the injection if necessary. Is the Hyaluronidase treatment painful? The discomfort during the procedure is minimal. Injector Maya will apply a topical numbing cream prior to the treatment and provide you with a special custom-made vibratory pain relief device. Can the treated areas be corrected after the dissolving? Injector Maya is an experienced injector and can certainly advise and correct the areas with dermal fillers. Can Hyaluronidase enzyme dissolve my own hyaluronic acid? Yes, however our own hyaluronic acid naturally lasts only 3 days and our skin will naturally reproduce the new hyaluronic acid to the same amount that has been dissolved in a couple of days. Are there any side effects of Hyaluronidase? The side effects are rare as listed below. Allergic reaction. Therefore, patch test 4 days prior the treatment is essential. Temporary swelling and bruising can be observed. Temporary skin laxity from fast deflated areas in the case of dissolving large amount of filler. Is there a downtime? The treated areas may swell up for 2-3 hours. Depending on amount of Hyaluronidase used, the swelling can last longer. The result of the dissolving can be seen typically 3-7 days although the enzyme still keeps working up to 14 days after. It is recommended not to touch or apply any make up on treated areas for 6 hours to prevent infection. Any swelling can be reduced by taking antihistamine. Bruising can be reduced with Arnica cream or tablets.
