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What you need to know about lip filler reversal with hyaluronidase

This week I saw a young patient aged 31 years old who had had lip filler for the first time and was unhappy with its appearance.

About three weeks earlier she had 1 mL of hyaluronidase filler.I am not allowed to mention the name of it here for obvious reasons.

It was a perfectly reasonable filler, done by an entirely good practitioner, but my patient did not like the cosmetic result.She had 0.7 mL into her upper lip by the needle after local anaesthetic cream and 0.3 in her lower lip also by the needle after local anaesthetic cream. 

She just did not like the upper lip, mainly where it gave her a slight pout or trout mouth appearance.I called it the downhill ski jump where from the side of the lips you can see that they are too projected and everted outwards. If you had a small pair of skis, you could ski down the upper lip philtrum and take off at the lip margin the vermillion border. 

We had a discussion about her treatment, and we both agreed that there was nothing wrong with the treatment, it was just that it was her first experiment with fillers. 

Many of her friends had been having lip filler so she thought she would do the same, but it did not work out for her.She is a very pragmatic, sensible girl, and she felt that she had given it time after three weeks. I had to agree with her as well that all the swelling from the initial treatment of her lips had settled down and it was not going to change now for probably six months to a year unless she had enzymatic treatment with hyaluronidase to reverse it.

It is my job as an oculoplastic surgeon who works with fillers in and around the face to advise patients carefully about the reversal of filler.Particularly in the lip, it can be quite tricky because the lip tissue is very dense.It is a very vascular area and also a very sensitive and tender area for any treatment.

I can do a reversal of lip filler with hyaluronidase and because it is a small area I tend to recommend only a small amount of enzyme in the first instance. I try to feel the lip to determine where the filler is. That can be quite difficult, particularly with some of the newer fillers which are designed to be very soft on the lip and barely noticeable as filler.

We then agreed to proceed once the patient is aware of the possible side effects. These are going to be bruising from my injection, discomfort from the injection, some swelling from the injection and of course the possibility that she may not like the effect of the reversal and wish again she had not had it done.

I have to counsel the patient about whether they want their filler reversed or not. Once we have decided they sign a specially prepared Clinica London consent form. Our medical advisory committee approves that form and is checked by our medical insurance to be acceptable to inform the patient about the risks and benefits of hyaluronidase for reversal of hyaluronate filler. 

I always stress to patients two important things about reversing fillers:

  1.  It is used off-licence meaning that it was never designed to be used for reversing hyaluronic filler, but it was designed and is sold in this country only and specifically to help the spread of drugs such as local anaesthetics during surgery or pain treatment.
  2. There is a genuine risk of allergy. If someone already has an allergy to foods or is atopic, then I insist that they have some Prednisolone and Piriton to take with them in the first 48 hours. We also always keep all patients under observation for 20 to 30 minutes afterwards and give them a cooled ice balloon to help reduce swelling. 

In the last three years, we have just had one patient who developed some lower face swelling following hyaluronidase. We immediately gave her Prednisolone because she had a little allergy. When that settled, we kept her on Prednisolone for two to three days. For those patients who do not have a history of allergy and it is their first time with hyaluronidase it is my clinical practice to give the patient a prescription for Prednisolone 10 mg a day for two to three days and Piriton 4 mg three to four times a day for a similar period.

The hyaluronidase enzyme works very quickly on the reversal of the hyaluronate gel, and usually, we know after about 10 minutes whether we have done enough reversal or not. The action can continue very slowly overnight, but about 90% of the action of the enzyme is achieved here in the clinic, and so both the patient and myself can see the effects and be satisfied with the result.

At Clinica London, I have a long experience of the use of hyaluronidase for reversal of hyaluronate filler. I specifically offer patients a one-stop treatment with assessment for £75 and treatment of enzyme for £225 making a total of £300. These figures are on the website visibly transparent so patients can identify the price before.

The reason we separate it into an assessment of £75 and treatment of £225 is that some patients are just wanting the evaluation and do not proceed with the enzyme. These may be patients who have only just had the filler, and I discuss with them that they should try and keep it for a little bit longer as it may well settle down and be entirely satisfactory for them. The website itself has many reviews about my professional expertise and specialist area of both injecting fillers and reversal of fillers done elsewhere. There is also a lot of information about Hylofix on the Clinica London website.

The type of patient who wants their filler reversed is typically like the one I have just described in this post, aged between 25 to 35 years usually following their first lip filler. I also reverse filler in the cheeks and the under eye area. If you would like to know more about this treatment, please contact our reception at Clinica London.

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