Pros, cons and everything else you need to know

Let’s travel back for a moment to 2019. The term “rich girl face” had just been coined by UK-based Dr. Dirk Kremer. This was an ode to women who flaunt their expensive, visible, non-invasive cosmetic treatments (ie Botox and dermal fillers) like they do expensive handbags. Society’s turn on the subject from the unthinkable to the encouraging has been swift and steady.

“Dermal fillers became very popular in 2019 when celebrities started talking openly about their procedures and the stigma associated with it disappeared,” said Dr. Shirley Sulaiman, founder of Cosmetic Injectables Center in Los Angeles, he told me. “Since then, it has been seen more as a skin maintenance treatment, just as we take care of our nails and hair. It is no longer considered taboo.”

Suleiman’s sentiments were supported by a Study 2022 conducted by the American Society of Plastic Surgeons (ASPS). The survey showed a 19% increase in cosmetic procedures since 2019 and an astronomical increase in minimally invasive procedures since the same year. Hyaluronic acid filler treatments increased by 70%, while 2022 was the first year that skin resurfacing and laser treatments were even detectable.

Dr. Mariana Vergara, founder of Beauty Villa Vergara in Beverly Hills, isn’t surprised by those numbers. “Over the years, dermal fillers have grown in popularity due to advances in technology,” he said. “Also, the use of social media has affected patients, making them more self-image and self-conscious. Celebrities and influencers create beauty trends and some even endorse certain brands. People accept them more and they are not so stigmatized.”

After all, the beauty industry is not slowing down. According Fortune Business Insightsthe facial injectables market size was valued at $8.47 billion in 2022 and is projected to grow from $8.89 billion in 2023 to $13.84 billion by 2030, exhibiting a compound annual growth rate (CAGR) of 6.5 % between 2023 and 2030. In the study, North America dominated the global market with a share of 47.57% in 2022.

Having said that, there was a recent discussion around his subject dissolving filler—the act of reversing modifications achieved by injectables. Amy Schumer went into detail in a 2021 Instagram post about it cheek filler removal. Meanwhile, in March 2023, TV personality Blac Chyna (née Angela White) the manner of dissolution of the filler is documented from her cheeks and chin on Instagram. Not until January 2024, reality star Francesca Farago documented removal of the filler from her chin, an area she had been dealing with for a decade.

Below is our experts’ breakdown of the pros and cons of filler dissolution and how to identify a candidate for the treatment.

What are dermal fillers?

Dermal fillers are the traditional gel-like injectable treatments you think of at the med spa that can enhance or plump up areas of the face. Some are only temporary and usually require no downtime.

“Dermal fillers can plump up deflated areas and straighten sunken areas to allow for a smoother contour to the skin,” explained the board-certified ophthalmic plastic surgeon. Dr. Robert Schwarz. “This creates a less shadowy and dark effect. I use them under the eyes, for example, to treat under eye hollows. I do this by filling in the skin so that when the light hits the face, there is less of a difference in the contour of the skin.”

There are several types of dermal fillers. As Schwarcz pointed out, the most popular forms include: hyaluronic acid (Juvéderm, Restylane), Poly-L-Lactic Acid/PLLA (Sculptra), calcium hydroxylapatite (Radiesse), and polymethyl methacrylate/PMMA (Bellafill).

“The most common dermal fillers are hyaluronic acid fillers because HA is a substance found in almost every living organism,” said the Beverly Hills ophthalmic plastic surgeon. Dr. Kami Parsa explained. “In humans, it acts as a network that transports essential nutrients from the bloodstream to skin cells. High concentrations are found in the soft connective tissues and fluid surrounding your eyes. It is also found in some cartilage and joint fluids, as well as in skin tissues.’

The crosslinked HA fillers The commonly used injections, however, are not the same as the natural HA found in our bodies. “These fillers can migrate and may never go away, causing problems in the long term,” Parsa said.

Why would anyone break up their fillers?

As with anything, it’s common to buck trends. There are filler patients (like Chyna, for example) who simply lack their natural appearance. There are also patients who undergo facial surgery, which requires removal of the filler. But there are some who experience lumps, migration, asymmetry, swelling and other side effects associated with filler injections.

“When areas are over-injected, filler can drastically change the appearance of the face, resulting in an unnatural appearance,” explained Dr. Vergara. “When too much filler is accidentally placed in an area, the area can appear exaggerated, swollen and puffy. Additionally, the filler can migrate if not injected at the correct level, causing it to travel to a different facial compartment and therefore lead to unevenness.”

The most recent public discussion of the migrated filler came into the hands of Kylie Jenner in January 2024, when he appeared at Paris Fashion Week with what is said holidays or moles under her eyes.

“There really is an epidemic of under eye fillers,” Dr. Parsa said. “Patients who aren’t good candidates for fillers make it. In reality, only 10% of people are real slot filler candidates.”

Dr. Parsa is adamant that patients are not candidates for under-eye fillers if they have bags, significant extra skin on their lower eyelids, retain fluid easily (waking up with puffy eyes in the morning), or have allergies.

“There is a small percentage of patients who are really candidates for fillers for the lacrimal cavities,” he says. “These patients don’t suffer from allergies or wake up with puffy eye bags. Our go-to filler for this area is Restylane, which has the least crossover.”

According to Dr. Schwarcz, “Most of the time these [botched] Patients would have seen a better result with an eye lift or blepharoplasty. Although these are surgical procedures, they will provide more natural and long-lasting results.”

Lips are the other area our experts have broken down the most.

“There was a trend between 2019 and 2023 where many injectors and patients were pushing for multiple syringes in the lip area — and sometimes with the wrong products and techniques,” said Dr. Suleiman. “This led to a lot of migration as the lips can hold so much gel in them. So it was a favorite procedure for me, to remove the excess and create a more natural, hydrated set of lips.”

Is every patient a candidate for filler dissolution?

While most patients with fillings are candidates for dissolution, there are cases where more drastic measures are required.

“If a patient has too much filler and the tissue stretches too much, we have to be careful with dissolution alone,” Dr. Parsa said. “In our protocol, we simultaneously loosen and tighten with radiofrequency micro-acupuncture. Some patients will need surgery if too much filler has been previously injected. If they’re not ready for surgery, then we tell them not to remove the filler if it’s not causing problems.”

The most important issue to note, however, is that even if one is a candidate for dissolution, the filler they used may not be.

“Only hyaluronic acid fillers can dissolve completely,” said Dr. Vergara. “This process depends on the type of HA used, as some come more cross-linked and are more difficult to dissolve. More sessions may be needed.”

Semi-permanent fillers like Sculptra or Radiesse cannot be dissolved – and on a slightly different note, no form of Botox can be dissolved. If someone is not a candidate to dissolve the filler or does not want to go through with the procedure, Dr. Suleiman advises microneedling with radiofrequency, which can dissolve fillers if placed in deeper settings. Otherwise, over time (usually 6 to 12 months), most fillers will naturally dissolve.

How does filler dissolve?

The dissolution process it looks similar to the filler injection procedure—but with a very different experience and a significantly lower price, ranging from $300 to $600. A dissolving enzyme called hyaluronidase (Hylenex or Vitrase) is required and from there it is injected under the skin and into the filler area.

“Hyaluronidase targets the bonds that hold the hyaluronic acid molecules together in the filler,” explained Dr. Parsa. “When these bonds are broken, the body can more easily absorb the hyaluronic acid fragments.”

Once injected, “The liquid causes a burning sensation that goes away after about 45 seconds,” Dr. Suleiman said. “The filler chains are broken down, absorbed by the body and discarded. The filler reversal effect can be seen within five minutes of injection and is complete in 24 hours. However, it takes three to 10 days for the tissue to settle down.”

Are there any risks associated with filler dissolution?

Although our experts have not reported any serious risks associated with the treatment, Dr. Soleiman advises patients to be cautious with Vitrase. The dissolving agent is derived from sheep and has a higher risk of allergic reaction than Hylenex, which is derived from human recombinant genes.

In addition to this, most patients are said to feel a burning sensation unlike anything they experienced when receiving the filler. There is also temporary bruising and possibly multiple sessions are required to complete the process.

Because fillers don’t naturally dissolve over time, Dr. Parsa said removing them abruptly can leave the skin stretched. This is also noted in a Dazed article detailing the possibilities risks and misconceptions undergo these treatments. Dr. Parsa often encourages clients to tighten loose skin with laser or fractional radiofrequency such as Morpheus8.

Popular content creator Meredith Duxbury revealed the implications of her acquisition lip filler dissolved in October 2023. While she was pretty bruised, she assured her TikTok followers that while they’re “a little squishy to the touch,” they’re “nothing crazy. I can eat, I can talk perfectly.”

But like so many others documented in the app, Duxbury said she may still be behind for (a little) more fullness.