When it Comes to Facial Fillers, Why Is Everyone Playing the Dissolve and Refill Game?

There’s a shift in the world of fillers right now, with more patients dissolving their fillers and, then (sometimes), refilling the area. Chalk it up to filler fatigue, poorly done fillers, migrating product, or a desire not to look so overtly plump—there’s no denying the uptick in dissolution.

When Filler Fatigue Sets In

A somewhat newer phenomenon, filler fatigue is the repetitive expansion and relaxation of tissues from filler injections, resulting in filler being less effective over time. “Whether it is true or not is debatable,” says Pittsburgh plastic surgeon Leo McCafferty, MD. Regardless, patients are flocking to their doctor’s offices to reverse the unjust effects of hyaluronic acid-based injectables.

A little product goes a long way, and natural is always better than overdone and obvious. Yet, as injectables grew in popularity over the years and the number of unqualified injectors increased, the uptick in subpar results multiplied, leaving those patients often desperate to undo the consequences.

New York dermatologist and founder of MM Skincare, Ellen Marmur, MD, credits TikTok with starting the craze of reversing hyaluronic acid fillers due to a plastic-y look. But it’s not just the way filler looks that has some patients opting to do a disappearing act; it can also be the occasional lump they feel. Dr. McCafferty says the angst of ‘overfill’ or lumpiness causes the patient and physician to reexamine aesthetic goals. “Remember, patients who have been getting fillers for five to 10 years continue to age, which influences things too,” he adds.

“When I have clients come to see me who are over-filled at another practice, it sometimes makes me cringe,” says Dover, OH, facial plastic surgeon David Hartman, MD. “This look is usually a matter of poor judgment by both parties—the patient and the injector.” His advice: consider doing less filler for a while. 

So, is this impending movement putting a screeching halt on facial fillers? Not quite. Glenn Dale, MD dermatologist Valerie D. Callender, MD, says she’s seeing more patients for filler, which will always exist in the doctor’s toolbox because of its volume-enhancing versatility when done properly.

What Happens When You Dissolve Filler

Only hyaluronic acid fillers are dissolvable with hyaluronidase, an enzyme antidote. If you’re looking to undo the effects of neuromodulators, Sculptra, or Radiesse, hyaluronidase will not work, and you’ll have to wait it out.

It’s more common to dissolve the filler in the tear troughs and lips, but every area is fair game. “All hyaluronic acid products are amenable to dissolution by hyaluronidase-type products, like Hylenex,” says Dr. McCafferty. However, you can expect minor bruising and swelling as the filler “melts away.” Generally, one to three sessions are required to erase the unwanted filler.

Now That It’s Gone, What’s Next?

After dissolving filler, you can go one of two ways: leave everything as is or re-volumize the area. 

The dissolve and refill approach is best for those who want to adjust the amount of filler in their face. Refill patients wish to avoid a puffy or overinflated face and don’t want to end up back where they just came from. That’s why it’s vital to see a board-certified dermatologist, plastic surgeon, or facial plastic surgeon to perform the treatment correctly. It’s also best to reinject the face in stages. “It is easier to add more filler than dissolve excess filler gradually,” Dr. Callender adds.

Some patients choose to move away from filler once and for all. Fat is an option (if you are willing to undergo surgery). As an alternative to lip filler, Botox Cosmetic can flip up the upper lip (aka a lip flip), which is a more conservative look than filler.

There’s also Renuva, an FDA-regulated extracellular matrix with the same collagen, growth factors, and proteins found in fat. Doctors use it in place of filler to reinstate volume by replacing the age-related fat loss by acting as a scaffold and allowing the body to build fat. Dr. Marmur uses it in thin, soft areas where fat grows, like the cheeks. “Renuva acts similarly to fat and can last up to 10 years, but not everyone wants liposuction, which is part of fat transfer,” she says. Injected similarly to filler, it’s unknown if Renuva is reversible if a patient is unhappy with their results.

No matter which road you choose to take, the goal is to create a natural look that boasts just the right amount of volume and definition in all the right places.

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