In 2019, U.K. based plastic surgeon, Dr Kirk Kremer, encapsulated the beauty standards of the time in a single phrase: Rich Girl Face. Described as a distinctively puffed and plumped visage, the look is achieved via an amalgamation of Botox injections and facial fillers, and was endorsed by celebrities in the vein of Kylie Jenner, Ariana Grande, and Iggy Azalea. “It is an instant, recognisable marker of wealth and status. Unlike generations before them, this new class of cosmetic injectee doesn’t hide its enhancements in shame,” states Dr Kremer in an interview for Glamour. “Rather, its plumped-up lips and puffer-fish cheeks are often a source of pride.”
Indeed, such procedures were widely embraced—and advocated—during that point in time. Netflix released an eight-episode series titled Skin Decision: Before and After in 2020; a reality series centering real-life patients undergoing various aesthetic procedures. The term ‘glow up’ then hit the mainstream, spawning numerous YouTube tutorials and Instagram reels showcasing how an individual could improve their physical appearance. Injectables were deemed to be (largely) non-invasive. In the wake of such mindsets, it comes as no surprise that many took the leap to go under the needle. But what happens after, when you’re less than satisfied with the results?
“Patients often seek to get facial fillers dissolved when they feel it makes them look worse off than before. This is a common problem especially around the mid-cheek or under eye area,” explains Dr Shauna Tan, aesthetic doctor at The Covette Clinic. “Common complaints include lumpiness under the eyes leading to a more tired appearance, or wanting a firmer or softer consistency for lip fillers—though there are a lot more factors as to why someone would want to get their fillers dissolved.”
This also begs the question: are there any risks to getting your fillers dissolved, and what does the procedure look like from start to finish? Vogue Singapore sits down with Dr Tan to get the lowdown, from the potential side effects to the necessary aftercare steps to know about.
First things first: What are facial fillers made up of, exactly?
“Dermal fillers are gel-like substances that are injected beneath the skin to restore lost volume, smooth lines, soften creases, and enhance facial contours. There are many different types of fillers available in the market today that are made up of different substances,” states Dr Tan. “Typically, fillers are made from Hyaluronic Acid (HA), Calcium Hydroxylapatite (CaHA), Poly-L-lactic Acid, Polymethylmethacrylate (PMMA) or autologous fat injections (fat derived from one’s own body via liposuction). Of the above named types of fillers, only HA fillers can be broken down and dissolved by an enzyme called hyaluronidase. The other products are not reversible or dissolvable.”
Why are people looking to dissolve their fillers as of late?
Beyond cultural or trend-based shifts, Dr Tan is also quick to point out that individuals may seek to dissolve their facial fillers due to poor technique or migration. For example, there are those who are simply not suited for fillers in specific regions, such as the under eye. “If one has festoons or malar mounds—which are areas of excess fluid collection or fluid accumulation that creates mild swelling, skin and fat compartments along with skin laxity— fillers can actually worsen the condition and result in an even more swollen appearance,” Dr Tan says. Improper technique on the part of the injector may also lead to a lumpy appearance, discoloration, or migration of the product to an unintended part of the face.
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Are there risks associated with the dissolving of facial fillers?
The common side effects comprise temporary discomfort at the injection site, redness, swelling, bruising and, very rarely, an allergic reaction. “When there is too much filler injected, this causes an over-filling of the tissues, which can lead to post-filler expansion where the tissue is stretched and loses elasticity. Once the filler is dissolved, the overlying skin and tissue become lax and can result in a worse off appearance. In these cases, I would recommend either to combine the dissolution with a skin tightening treatment such as an RF microneedling treatment or even surgical intervention to remove the excess skin,” Dr Tan points out.
Tell us about how the procedure goes.
The process is dependent on the complexity of the case. Dr Tan finds that some cases require imaging prior to the procedure, ranging from ultrasound to MRI imaging. “This is so we can better visualise the location and amount of filler we need to dissolve. I would then counsel the patient at length about the risks described above and give pre-injectable advice such as holding off on aspirin, ibuprofen, or vitamin E for at least a week prior to your treatment to minimise the risk of excessive bleeding or bruising,” reports Dr Tan. “I also plan out the areas of injection and explain the plan to the patient. In the case of an overfilled face, I would usually recommend multiple sessions so the changes are more gradual so as to avoid knee-jerk decisions to refill the area.”
On the day of the procedure itself, numbing cream is provided to optimise patient comfort. The areas for dissolving are then marked out, and the hyaluronidase is then injected via a needle. “When the enzyme enters the tissue there can be a slight burning sensation which lasts for about 30 to 45 seconds,” Dr Tan claims. “I then proceed to perform a gentle massage over the area to facilitate the spread of the enzyme.Early signs of filler reversal can usually be seen as quickly as 5 to 10 minutes post-injection, but is usually completed by 24 to 48 hours. I usually advise my patients to wait for around 3 to 7 days before observing the final result.”
What does aftercare look like once you’ve had your facial filler dissolved?
It is recommended to avoid alcohol, exercise, and strenuous activity for the first 24 hours post-procedure. Also, it is best to avoid extreme heat as well as cold. Dr Tan also advises not to apply pressure to the affected area.
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