Manual filler removal using ultrasound-guided cannula suction/aspiration is a relatively new and emerging technique, and while some doctors offer this approach, it is not yet widely adopted. Here are some considerations regarding the feasibility, risks, and general thoughts on this method: Feasibility: Precision: One of the key benefits of using ultrasound guidance is the ability to locate the filler precisely in deeper tissue planes. This technique allows the injector to visualize exactly where the filler is and target it more accurately than traditional blind aspiration or dissolving with hyaluronidase. Aspiration Method: The idea behind using a cannula for suction/aspiration is that it provides a minimally invasive way to physically remove the filler. This can be beneficial if a patient has experienced overfilling or filler migration and prefers mechanical removal rather than dissolving agents like hyaluronidase, which may affect natural tissues or result in uneven dissolving. Risks: Invasive Nature: While it's less invasive than surgery, any procedure involving a cannula carries risks, including: Infection: Inserting a cannula to remove filler carries a small risk of introducing bacteria, which could lead to infection. Scarring or Tissue Damage: Depending on how deep the filler is and how aggressively it's removed, there may be a risk of scarring or trauma to the underlying tissue, particularly if the cannula causes damage during the aspiration process. Incomplete Removal: Filler tends to integrate with the surrounding tissues over time, and physical removal might not always be able to extract 100% of the product, especially if the filler has migrated or diffused over a larger area. Some areas may still require additional hyaluronidase treatment to fully remove the filler. Ultrasound Accuracy: While ultrasound is helpful for visualization, it depends on the skill of the provider. If the practitioner is not highly experienced with ultrasound-guided procedures, there’s a risk of missing some areas of filler or causing tissue injury. Unknown Long-Term Outcomes: Since this method is still relatively new and not well-documented in the scientific literature, there may be unforeseen long-term risks or complications. The lack of large-scale studies means there isn’t yet comprehensive data on long-term success rates or safety. Benefits: Avoiding Hyaluronidase: For individuals who have concerns about using hyaluronidase due to allergic reactions, fear of over-dissolution, or preferring not to use it, manual removal could be a viable alternative. Controlled Filler Removal: This method may offer better control over how much filler is removed, avoiding the risk of dissolving natural tissue along with the filler, which is a potential issue with hyaluronidase.