Ultrasound-guided filler dissolving

Hyaluronic acid (HA) filler can be broken down with an enzyme called hyaluronidase. People ask for it when filler has moved, feels lumpy, looks uneven or shows as a bluish tinge under the skin, or when they simply no longer want it.

With ultrasound guidance, the area is scanned first. The scan shows where the filler sits and the tissue around it, so the enzyme can be placed directly into the filler. This matters because the enzyme is broken down quickly in the body, so it needs to reach the filler to work. The evidence for ultrasound guidance comes from small studies.

Hyaluronidase is a prescription-only medicine in the UK, and using it to dissolve filler is an off-licence use, which we'll explain before you agree to treatment. It works only on hyaluronic acid, so it can't dissolve other types of filler, such as calcium hydroxylapatite or polycaprolactone.

Allergic to bee or wasp stings? Tell us at your consultation: it raises the risk of an allergic reaction to hyaluronidase. If you're not sure which filler you had, bring any details you have. If dissolving isn't right for you, we'll say so.

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   Step 1: Your history

   We ask which filler you had, where and when, and about your health, your medicines and any allergies, including to bee or wasp stings.

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   Step 2: The scan

   A thin layer of gel goes on the skin, and a small ultrasound probe shows where the filler sits and the tissue around it.

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   Step 3: The treatment

   Guided by the scan, the enzyme is placed into the filler with a fine needle. The area may be massaged afterwards to help it work.

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   Step 4: Your review

   We check the area again and tell you what to expect. Sometimes a further session is needed.

Common and expected

Discomfort during and after the injections, redness, swelling and bruising.

Less common

An allergic reaction, usually in the treated area: redness, swelling or itching that lasts, or comes on days later. A skin test can't predict every delayed reaction. Not all of the filler may dissolve in one session, so a repeat is sometimes needed.

Rare but serious

A severe allergic reaction affecting the whole body is rare, but it's an emergency, which is why we ask about allergies first.