Not every hyaluronic acid treatment turns out the way it was imagined. Sometimes a lip looks fuller than planned, a filler settles unevenly, or the face as a whole appears heavier than before. Unlike most filling materials, hyaluronic acid is reversible: with the enzyme hyaluronidase, widely known by the brand name Hylase®, injected hyaluronic acid can be dissolved again in a targeted way.
Dr Özdemir performs this correction at his practice in Vienna-Döbling, including cases where the original treatment was carried out elsewhere.
When does dissolving hyaluronic acid make sense?
- Lips, cheeks or chin look overfilled or unnatural.
- The filler sits asymmetrically, in strands, or as a palpable nodule.
- Hyaluronic acid lying close beneath the skin shines through with a bluish tint (Tyndall effect), particularly under the eyes.
- The filler has migrated. On the lips in particular it moves beyond the natural contour over the years.
- Swelling or nodules have not settled weeks after the treatment.
- Before rebuilding: a depot that has accumulated over the years is removed first, so the area can then be rebuilt more sparingly.
The simple wish to return to your original appearance is reason enough. You do not need a medical problem to ask for dissolution.
Also after treatments at another practice
Many of the patients who come to have filler dissolved were originally treated elsewhere. This is a common reason to come and no cause for an awkward conversation.
It helps if you can bring information on which product was used, how much was injected and when the treatment took place. This is often stated on the invoice or treatment record. If those details are not available, treatment is still possible: the assessment is then based on palpation and appearance. Dosing is more cautious, and a second session follows if required.
What can be dissolved and what cannot
Hyaluronidase acts on hyaluronic acid only. All common hyaluronic fillers can be broken down with it, regardless of manufacturer. More heavily cross-linked, particularly firm products require somewhat more enzyme or a second session.
Permanent and semi-permanent materials such as silicone oil, polymethyl methacrylate (PMMA), poly-L-lactic acid or calcium hydroxylapatite cannot be dissolved. They do not respond to the enzyme. If it is unclear what was injected, this is addressed before treatment: attempting to dissolve permanent material achieves nothing, and you should not pay for a treatment that cannot work in your case.
How the treatment works
It begins with a detailed consultation and examination of the treated area. Your medical history is taken as well, including any known allergies: allergic reactions to hyaluronidase are rare but possible.
The treatment itself takes around 15 to 30 minutes. The enzyme is placed with a very fine needle exactly where the hyaluronic acid lies. On request, the skin is prepared beforehand with a numbing cream; an injected local anaesthetic is usually not necessary.
Dosage is what matters. Only as much is dissolved as needed: on the lips especially, the difference between a balanced correction and a result that looks too empty comes down to a few units. The approach is therefore deliberately conservative, with the option to refine later.
After the treatment
The enzyme starts working immediately; the breakdown is largely complete within 24 to 48 hours. An initial change is often visible right after the treatment, but the final result can only be judged after two to three days, once the swelling caused by the treatment itself has subsided.
The injection points may show mild swelling, redness and tenderness. As a rule you are presentable again after one to two days. You should avoid sport for about two days, as well as sauna and intense heat.
Where a very firm depot has built up over years, a second session may be required. It takes place no earlier than one to two weeks later, so that the result of the first treatment can be judged reliably.
Rebuilding after dissolution
If you would like filler again after the correction, the usual waiting period is two to four weeks. Hyaluronidase temporarily breaks down part of your body's own hyaluronic acid in the treated area as well; this regenerates by itself within a few weeks. Waiting gives you a more reliable and longer-lasting result.
What are the risks of dissolving with hyaluronidase?
Your body's own hyaluronic acid is broken down too. The enzyme does not distinguish between injected and naturally occurring hyaluronic acid. Immediately after treatment, the area can therefore look more sunken than before the original filler was placed. This is temporary — your body's own hyaluronic acid normally rebuilds itself within a few days to weeks.
Allergic reactions. Hyaluronidase is derived from animal tissue. Genuine allergic reactions are rare but possible — ranging from skin redness to severe reactions. Dr. Özdemir therefore asks about known allergies before treatment.
Swelling, redness, bruising. Normal in the first hours to days after treatment.
The result cannot be finely dosed. How much dissolves depends on the amount, the product and the tissue. Sometimes a second session is needed; sometimes more dissolves than intended. An area that has been over-dissolved can be built up again later, but not on the same day.
Not every material dissolves. Silicone oil, PMMA (polymethyl methacrylate), poly-L-lactic acid and calcium hydroxylapatite do not respond to the enzyme. If it is unclear what was originally injected, this needs to be clarified beforehand.
Is there an alternative to dissolving?
Waiting. Hyaluronic acid breaks down by itself, over several months to around eighteen months depending on the product and region. If you can live with the result, there is nothing you need to do. The one exception is encapsulated hyaluronic acid: if the body has formed a capsule around the injected hyaluronic acid, this is usually felt as a permanent lump. Encapsulated hyaluronic acid can only rarely be dissolved with hyaluronidase. If the lump is bothersome or becomes inflamed, surgical removal is usually the only remaining option.
Adjusting the other side instead of dissolving. For an irregularity or asymmetry, the more targeted solution is sometimes to adjust the opposite side rather than dissolve everything. This depends on the findings.
No waiting with vascular occlusion. If pain, paleness or discoloration appear after a filler injection, this is an emergency, not a case for patience. It must be dissolved immediately.
Consultation in Vienna-Döbling
Not every unsatisfactory result needs to be dissolved. Shortly after a treatment much of what you see is still swelling and settles on its own; sometimes a small addition elsewhere is enough to bring the area back into balance. What makes sense in your case is something we discuss during the consultation.
