Filler Dissolving

What hyaluronidase is

Hyaluronidase is an enzyme — present naturally in the human body and produced as a prescription-only medicine for clinical use — that breaks down hyaluronic acid. Because virtually all modern dermal fillers used in cosmetic treatment are HA-based, hyaluronidase is the standard reversal tool when HA filler needs to be removed or reduced.

Beyond its routine cosmetic use, hyaluronidase is the urgent reversal agent for vascular events during filler treatment — the situation where filler is accidentally injected into or compressing an artery, threatening tissue blood supply. Every clinic offering HA filler must have hyaluronidase on site and clinicians trained to use it. We do.

When dissolving is the right next step

Dissolving is the right next step in several common scenarios:

• Migration: filler has spread beyond intended placement. The most common example is HA filler placed in the body of the lip migrating above the upper lip border, producing a "moustache" or shelf appearance.
• Over-filling: too much volume has been placed, distorting proportion. Common in lips, cheeks and chin.
• Tyndall effect: superficial tear-trough filler producing a bluish tint under the eye.
• Nodules and lumps: discrete palpable or visible deposits.
• General reset: long-standing, layered-up filler that needs to be cleared before a fresh, considered approach can be planned.

Our two-stage approach

We treat dissolving as a deliberate, two-stage process at Aesthetic Clinique in West Hampstead:

1. Dissolve. Targeted injections placed precisely into the filler depot — with measured doses, not maximum doses, because hyaluronidase will also temporarily affect the body's own native HA in surrounding tissue.
2. Wait 2–4 weeks. During this window, residual filler continues to break down, native HA regenerates, and the underlying tissue settles into its natural shape. Only then can we accurately plan whether anything new is appropriate.

We will not refill at a dissolving appointment. The two decisions — what to remove, and what (if anything) to add — must be separated, in writing and in time.

Who suits the treatment — and who doesn't

It suits any patient with HA filler they want reduced, removed or reset. It is not effective on non-HA fillers (silicone, polymethylmethacrylate and similar permanent or semi-permanent products), and we will not inject hyaluronidase if we are not confident the filler in question is HA. It is contraindicated in patients with known hyaluronidase allergy, and is approached with caution in patients with bee or wasp sting allergy because of recognised cross-reactivity.

We allergy-screen every patient. A patch test is offered in most cases, particularly for first-time hyaluronidase use, and we have full anaphylaxis-management equipment on site.

What to expect on the day, and over time

Treatment takes around an hour including consent, screening and recovery. Immediate post-injection swelling — particularly in the lips — is normal and can be dramatic for the first few hours; the treated area can temporarily look larger before it begins to reduce. Visible improvement begins at 24–48 hours; full effect develops over 1–2 weeks.

We see you at 2–4 weeks for reassessment. If dissolving is complete and you are content with the result, that is the end of treatment. If further dissolving is needed, a second session is planned. If new filler is appropriate, that becomes a separate consultation and treatment cycle.