Aesthetic Impacts of Elective Hyaluronidase Dissolution: A Case Report Highlighting the Restorative Benefits of Dermal Fillers
Main Article Content
Abstract
Introduction and Importance: Dermal fillers are pivotal in aesthetic enhancement, offering minimally invasive solutions for facial rejuvenation. This case underscores the stark contrast in appearance following elective hyaluronidase dissolution of long-term fillers and examines the challenges of transitioning to fat transfer as an alternative.
Presentation of Case: A 50+ year-old Asian female, with a history of dermal fillers over 10 years, sought hyaluronidase dissolution to facilitate fat transfer. The dramatic aging effects post-dissolution left the patient deeply dissatisfied. Subsequent fat transfer in another country failed to meet aesthetic expectations, despite undergoing 2 sessions.
Clinical Discussion: This report highlights the transformative benefits of dermal fillers, the risks associated with high-dose hyaluronidase, and the complexities of achieving comparable outcomes with fat transfer.
Conclusion: Properly placed fillers provide profound aesthetic benefits. The case underscores the importance of careful evaluation before administration of hyaluronidase.
Keywords:
Hyaluronidase, Dermal Fillers, Post-Hyaluronidase Syndrome, Aesthetic Medicine, Fat Transfer, Facial Rejuvenation
Article Details
How to Cite
RAMIREZ, Sylvia Paz Baens; SCHERZ, Gunther.
Aesthetic Impacts of Elective Hyaluronidase Dissolution: A Case Report Highlighting the Restorative Benefits of Dermal Fillers.
Medical Research Archives, [S.l.], v. 13, n. 6, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6650>. Date accessed: 15 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6650.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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23 J. Faivre, K. Wu, M. Gallet, J. Sparrow, F. Bourdon, and C. J. Gallagher, “Comparison of Hyaluronidase-Mediated Degradation Kinetics of Commercially Available Hyaluronic Acid Fillers In Vitro,” Aesthet. Surg. J., vol. 44, no. 6, pp. NP402–NP410, Feb. 2024, doi: 10.1093/asj/sjae032.
24 S. B, B. F, H. V, E. R, W. L, and R. B, “The current state of treatment of adverse reactions to injectable fillers,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/20969667/
25 M. M, “Hyaluronic Acid Filler Longevity and Localization: Magnetic Resonance Imaging Evidence,” PubMed, 2021, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/33002985/
26 Jung GS. Thoughts and Concepts in Ultrasonography-guided Hyaluronidase Injection Technique. Plast Reconstr Surg Glob Open. 2023 Jun 13;11(6):e5041. doi: 10.1097/GOX.0000000000005041. PMID: 37325378; PMCID: PMC10263199.
27 V. M, V. A, and N. K, “Dermal Fillers: Do’s and Dont’s,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/20606986/
2 E. Papakonstantinou, M. Roth, and G. Karakiulakis, “Hyaluronic acid: A key molecule in skin aging,” Dermatoendocrinol., vol. 4, no. 3, pp. 253–258, Jul. 2012, doi: 10.4161/derm.21923.
3 “American Society of Plastic Surgeons,” American Society of Plastic Surgeons. Accessed: May 13, 2025. [Online]. Available: https://www.plasticsurgery.org/
4 D. Ho and J. Jagdeo, “Safety and Efficacy of a Volumizing Hyaluronic Acid Filler for Treatment of HIV-Associated Facial Lipoatrophy,” JAMA Dermatol., vol. 153, no. 1, pp. 61–65, Jan. 2017, doi: 10.1001/jamadermatol.2016.3827.
5 R. J. Rohrich et al., “Facial soft-tissue fillers: Assessing the state of the science conference - Proceedings report,” Plast. Reconstr. Surg., vol. 127, no. SUPPL. 4 S, pp. 9S-21S, Apr. 2011, doi: 10.1097/PRS.0b013e31820578b9.
6 S. Cotofana, R. H. Gotkin, K. Frank, N. Lachman, and T. L. Schenck, “Anatomy Behind the Facial Overfilled Syndrome: The Transverse Facial Septum,” Dermatol. Surg. Off. Publ. Am. Soc. Dermatol. Surg. Al, vol. 46, no. 8, pp. e16–e22, Aug. 2020, doi: 10.1097/DSS.0000000000002236.
7 “The filler industry bombshell that triggered a panicked ‘glow-down’ trend,” Cosmopolitan. Accessed: May 13, 2025. [Online]. Available: https://www.cosmopolitan.com/uk/beauty-hair/celebrity-hair-makeup/a35708681/celebrities-dissolve-filler-amount-tweakment/
8 H. Jung, “Hyaluronidase: An overview of its properties, applications, and side effects,” Arch. Plast. Surg., vol. 47, no. 4, pp. 297–300, Jul. 2020, doi: 10.5999/aps.2020.00752.
9 D. Funt and T. Pavicic, “Dermal fillers in aesthetics: an overview of adverse events and treatment approaches,” Plast. Surg. Nurs. Off. J. Am. Soc. Plast. Reconstr. Surg. Nurses, vol. 35, no. 1, pp. 13–32, 2015, doi: 10.1097/PSN.0000000000000087.
10 F. D and P. T, “Dermal fillers in aesthetics: an overview of adverse events and treatment approaches,” PubMed, 2013, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/24363560/
11 C. DeLorenzi, “Complications of Injectable Fillers, Part 2: Vascular Complications,” Aesthet. Surg. J., vol. 34, no. 4, pp. 584–600, May 2014, doi: 10.1177/1090820X14525035.
12 G. Murray, C. Convery, L. Walker, and E. Davies, “Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol,” J. Clin. Aesthetic Dermatol., vol. 14, no. 8, pp. E69–E75, Aug. 2021.
13 M. Alam et al., “Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules: A Randomized Clinical Trial,” JAMA Dermatol., vol. 154, no. 7, pp. 765–772, Jul. 2018, doi: 10.1001/jamadermatol.2018.0515.
14 C. Yz, P. G, and A.-N. F, “Dermal fillers: pathophysiology, prevention and treatment of complications,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/27662522/
15 M. King, C. Convery, and E. Davies, “This month’s guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4),” J. Clin. Aesthetic Dermatol., vol. 11, no. 6, pp. E61–E68, Jun. 2018.
16 D. B. K and H. I, “Patient factors influencing dermal filler complications: prevention, assessment, and treatment,” PubMed, 2015, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/25926750/
17 M. Landau, “Hyaluronidase Caveats in Treating Filler Complications,” Dermatol. Surg. Off. Publ. Am. Soc. Dermatol. Surg. Al, vol. 41 Suppl 1, pp. S347-353, Dec. 2015, doi: 10.1097/DSS.0000000000000555.
18 C. Sohrabi et al., “The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines,” Int. J. Surg. Lond. Engl., vol. 109, no. 5, pp. 1136–1140, May 2023, doi: 10.1097/JS9.0000000000000373.
19 “S. Korea sees surge in foreign patients for beauty care, plastic surgery | The Straits Times.” Accessed: May 13, 2025. [Online]. Available: https://www.straitstimes.com/asia/east-asia/s-korea-sees-surge-in-foreign-patients-for-beauty-care-plastic-surgery
20 C. L. Wilde, K. Jiang, S. Lee, and D. G. Ezra, “The Posthyaluronidase Syndrome: Dosing Strategies for Hyaluronidase in the Dissolving of Facial Filler and Independent Predictors of Poor Outcomes,” Plast. Reconstr. Surg. Glob. Open, vol. 12, no. 4, p. e5765, Apr. 2024, doi: 10.1097/GOX.0000000000005765.
21 R. L, R. C, C. L, Z. Us, K. H, and C. L, “Adverse reactions to injectable soft tissue fillers,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/21167403/
22 J. Mlw, L. Mk, and M. Es, “The Kinetics of Reversible Hyaluronic Acid Filler Injection Treated With Hyaluronidase,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/28498207/
23 J. Faivre, K. Wu, M. Gallet, J. Sparrow, F. Bourdon, and C. J. Gallagher, “Comparison of Hyaluronidase-Mediated Degradation Kinetics of Commercially Available Hyaluronic Acid Fillers In Vitro,” Aesthet. Surg. J., vol. 44, no. 6, pp. NP402–NP410, Feb. 2024, doi: 10.1093/asj/sjae032.
24 S. B, B. F, H. V, E. R, W. L, and R. B, “The current state of treatment of adverse reactions to injectable fillers,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/20969667/
25 M. M, “Hyaluronic Acid Filler Longevity and Localization: Magnetic Resonance Imaging Evidence,” PubMed, 2021, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/33002985/
26 Jung GS. Thoughts and Concepts in Ultrasonography-guided Hyaluronidase Injection Technique. Plast Reconstr Surg Glob Open. 2023 Jun 13;11(6):e5041. doi: 10.1097/GOX.0000000000005041. PMID: 37325378; PMCID: PMC10263199.
27 V. M, V. A, and N. K, “Dermal Fillers: Do’s and Dont’s,” PubMed, Accessed: May 30, 2025. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/20606986/