Dermal fillers have become a societal norm. And for some, getting injected has become as routine as getting their quarterly hair color done. But what happens when you want to undo the work? As more people—including high-profile celebrities—opt to dissolve their fillers, the hidden dangers of using Hyaluronidase are coming into the spotlight. While it’s often marketed as a simple fix, patients are discovering that filler dissolving can lead to unexpected and long-lasting consequences, ranging from facial deformities to emotional distress.
But let’s be very clear – this article is not to dissuade you from getting a little filler – we love to support our cosmetic practitioners out there. This is more to educate on the risks (and *informed consent*), along with highlighting the importance of communicating with a trusted practitioner about your procedure.
The Role of Hyaluronic Acid and Hyaluronidase in the Body
Just because your body “already makes” hyaluronic acid doesn’t mean it’s safe to inject anywhere. That’s the case for both Hyaluronic acid-based fillers and Hyaluronidase.
Hyaluronic acid (HA) is essential for the proper functioning of the human body. It plays a crucial role in cellular communication, muscle function, and skin healing. Without it, even minor skin damage wouldn’t be able to heal properly, and your body’s systems would struggle to function. This makes hyaluronic acid not just beneficial for making our skin healthy and beautiful, but also necessary for survival.
Because it is so vital, your body carefully regulates its hyaluronic acid levels. It doesn’t constantly produce the enzyme hyaluronidase, which breaks down hyaluronic acid, because your body relies on a steady supply of HA to stay healthy.
Hyaluronidase, on the other hand, is a naturally occurring enzyme that breaks down hyaluronic acid. Its found in the body’s connective tissue, skin, and fluids throughout the body. Hyaluronidase is typically only produced when necessary, such as during an infection, and for short periods of time.
For instance, when your body is fighting a bacterial infection, your white blood cells secrete hyaluronidase to break down the protective hyaluronic acid layer around the bacteria (this allows the immune system to destroy the bacteria.) This process is tightly controlled, and hyaluronidase is only deployed to specific areas where it’s needed.
This brings us to a key point: just because the body produces hyaluronic acid and hyaluronidase doesn’t mean it’s safe to inject these substances anywhere. The body’s natural use of hyaluronidase is precise and localized, and the assumption that it can be freely injected to dissolve filler across the face without risk is flawed. When hyaluronidase is introduced in large amounts or in inappropriate areas, it can break down not just the filler but also the body’s own hyaluronic acid, potentially causing damage beyond what was intended.
The Hidden Risks of Hyaluronidase
While hyaluronidase has been marketed as a quick solution for removing unwanted fillers, it comes with its own set of risks. One major concern is that hyaluronidase doesn’t just break down the filler—it can also dissolve your body’s natural hyaluronic acid, which helps maintain skin hydration and structure. This can lead to thinning skin, hollow areas, and even facial sagging.
Mirela’s story highlights the potential dangers. After getting hyaluronic acid filler in her lips, she noticed it migrating above her lip and opted to have it dissolved with hyaluronidase. Soon after the treatment, she experienced burning sensations in her face, neck, and arms, along with weakness and facial changes. Over time, her eyes began to sink into her face, and she lost significant skin volume.
Hyaluronidase side effects
Mirela isn’t alone. Thousands of people have turned to Reddit (two million in this group alone) and social media support groups to share similar experiences with side effects after hyaluronidase injections.
Patients are reporting issues like:
- Burning sensations in the face and limbs
- Loss of skin volume and elasticity
- Skin discoloration
- Neuralgia, headaches
- Dry eye syndrome
- Autoimmune symptoms
- Fatigue
- Pain and pressure throughout the face
These side effects point to a larger issue: the lack of extensive clinical research on the long-term effects of hyaluronidase in cosmetic treatments. Though it has been used for decades to aid in procedures like dissolving local anesthetics, its off-label use for filler removal remains under-researched and inconsistently regulated.
The Psychological Toll & Medical Gaslighting
For many patients, the physical effects of filler dissolving are just the beginning. The emotional toll can be just as damaging. When individuals experience side effects or complications, they often find themselves dismissed by practitioners or doctors who claim their issues are imagined or unrelated to hyaluronidase. This phenomenon, known as medical gaslighting, leaves patients feeling helpless and ignored.
Mirela, for instance, sought help from her injector after experiencing severe side effects but was told to visit a general practitioner. When she did, the doctor sent her back to the injector, leading her in circles with no real solution. Stories like hers are not uncommon. Many people report being stuck in medical limbo, dismissed by doctors, and left to deal with the fallout of their treatments on their own.
Adding to the distress is the overwhelming presence of social media. While platforms like Instagram and TikTok once glorified the “pillow face” look and exaggerated features, they are now filled with stories from men and women who have had negative experiences with filler dissolving. Support groups with thousands of members are emerging as a safe space for those who feel abandoned by the medical community.
Myths and Misconceptions About “Temporary” Filler
Hyaluronic acid fillers are often marketed as temporary, with claims that the body will naturally break them down over time. However, this is not always the case. Many med spas and plastic surgeons fail to address the fact that fillers tend to migrate from their original placement, often moving into unintended areas of the face before they fully dissolve (which can take over ten years, if so.) This migration can lead to the overfilled “pillow face” look, prompting individuals to seek more filler in an attempt to balance their features.
Additionally, filler migration can affect the lymphatic system, causing long-term swelling and changes in facial structure. Synthetic hyaluronic acid, which is more cross-linked than the natural substance found in the body, is harder for the body to break down and can linger for years. MRI’s have shown that some patients still have remnants of filler in their face over a decade after their initial injections.
MRI Scan showing filler migration of 33 year old female. Image credit: Dr. Kami Parsa
The Need for Better Regulation
Despite its increasing use, hyaluronidase remains underregulated in the cosmetic industry. There are no universal standards for how much of the enzyme should be used or how to safely administer it for dissolving fillers. As a result, patients can experience inconsistent results, with some reporting success and others facing long-term complications.
Experts like Dr. Paul Charlson and Dr. Naveen Somia have called for stricter regulation, highlighting the risks of using hyaluronidase without clear guidelines. A study by Dr. Daniel Ezra also revealed that 20% of patients studied reported negative side effects, such as skin contour changes and discoloration, after dissolving their fillers. This lack of consensus around the safe use of hyaluronidase means that many patients are left vulnerable to unpredictable outcomes.
What Can You Do to Protect Yourself?
Before deciding to dissolve your fillers, it’s important to understand the potential long-term consequences. Here are some steps you can take to protect yourself:
- Consult a qualified professional: Ensure that your practitioner is medically trained and experienced in administering hyaluronidase. Ask about their past experiences with filler dissolving and don’t hesitate to seek additional opinions.
- Don’t be afraid to ask – in detail – about the risks of hyaluronidase: Be fully informed about the possible side effects of hyaluronidase, especially if you have had large amounts of filler or filler for a long period.
- Consider alternatives: Explore non-invasive options like RF microneedling or laser treatments before choosing to dissolve your filler with hyaluronidase. These treatments can sometimes help resolve filler issues without the need for enzyme injections, although treatments involving high heat definitely have serious risks of their own too, such as facial fat loss.
Conclusion: The Reality Behind the “Quick Fix”
Dissolving fillers might seem like a quick and easy solution to fixing or getting rid of your filler, but the reality is far more complicated. As stories from patients like Mirela show, the consequences of using hyaluronidase can extend far beyond the initial procedure and leave to permanent physical and emotional damage.
Before making the decision to reverse your fillers, make sure you’re fully informed and consult trusted professionals. While the desire to return to a more natural look is understandable, it’s important to consider the potential long-term risks of filler dissolving.
If you’ve experienced complications with dissolving fillers, share your story below and help advocate for better regulation and safer practices within the cosmetic industry.
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