Dissolving Fillers
Hyaluronic fillers are the most commonly used type of dermal fillers. They attract water and help restore lost volume or create volume in areas that previously did not have enough desired volume, such as in the lips. Hyaluronic acid is a naturally occurring substance that is present in our faces and the hyaluronic acid in dermal fillers is chemically treated to last longer. Different brands have different properties, with some being soft or firm, stiff or flexible, more or less fluid attracting. They are used for different areas to create best results.
As their popularity has grown, more scientific knowledge has emerged about their longevity and how fillers behave when injected into the face.
Fillers last much longer than previously thought. On ultrasound and mri, they have been documented for up to 15 years. They are compressed by muscles and connective tissues and move along tissue planes. Fillers take the paths of least resistance, and the cannula or needle tracks create ways for filler to move.
Our faces are continuously aging, with loss of bone, muscle and deep fat, which are all supportive. Filler helps maintain the appearance of a contoured, youthful face. It gets broken down and compressed by muscles over time, but does accumulate, flattening the age curve.
Respect for anatomy means conservative use of filler, to avoid the dreaded alien face, potato face or duck lips. Sometimes, too much filler is placed or it is placed in the wrong plane, too deep or too superficial. This may create nodules, bluish skin discoloration or a puffy appearance. Filler may also compress veins, causing intermittent redness and swelling, particularly after exposure to heat, such as after exercise or a sauna.
Lips are a very popular area to be treated with fillers. They are a small space and certain injection techniques; more water attracting fillers and repeat treatments make ducking more probable. Filler can spread above the lip to duck or below the lip to cause bubble like bumps. Placing more filler is not recommended, as that will just push the older filler more into view and look less natural. First dissolving filler, waiting a week or so and then refilling will give the optimal results.
Another area that is predisposed to puffiness after fillers is the under eye area. The tear trough area is very anatomically complex, small and unforgiving. It is best to treat the midface and temples in order to support the under eye area and then do the least amount of filler to the tear trough, so as not to disrupt the lymphatics which run here. In other parts of the face, we have naturally occurring hyaluronidase, the enzyme that breaks down filler. In the under eye area there is none. Undereye filler is permanent unless dissolved and continues to draw in water over time. Therefore, less is more.
Hyaluronidase is an enzyme available to dissolve hyaluronic fillers. It can be injected and causes filler dispersal. Sometimes the filler develops a capsule around itself and ultrasound can be used to directly see the filler get dissolved. Allergic reactions are rare but potentially can occur. There is always some swelling after hyaluronidase and it takes at least a few days to resolve. Some fillers are more difficult to dissolve than others. Depending on the quantity and type of filler, multiple sessions of dissolving may be necessary.
Please call 860-999-4865 to schedule your consultation with Dr. Shternfeld, a Board-Certified Ophthalmologist.
