Fillers won't go away, help!

Question

I have had lip filler since i was 18 years old, im now 35. 5 years ago i got them dissolved due to migration and got revolax injected. I now want to do a fat transfer bc i dont want to have a foreign object. But the filler wont go away! I dont want to do dissolver again bc i have seen my friends get horrible side effects. What are my options?

Kenneth D. Steinsapir, MD · Answer

You do not have friends with horrible side effects from hyaluronidase. The enzyme does not wreck the skin. It does require an injector who knows how to remove ancient filler. This requires several round of large dosage enzyme treatments. Likely you do not need fat transfer which is honestly a terrible procedure. Likely what you need is your ancient fillers removed. Hope you get the care you need.

Anna Chacon, MD, FAAD · Answer

I can understand why you'd want to move away from fillers after so many years and choose something more permanent like a fat transfer. You're also not alone in noticing that your filler seems to last much longer than expected.

Although hyaluronic acid fillers are marketed as temporary, we've learned over the past several years that some fillers can persist for much longer than originally believed. In some patients, residual filler is still detectable on ultrasound or MRI several years after treatment, particularly after repeated injections.

In your case, there are a few possibilities:

There is still residual Revolax present.
There may be scar tissue from years of injections that is contributing to the shape of your lips.
It may be a combination of both.

Before considering fat grafting, I would strongly recommend confirming whether filler is actually still present. One of the most helpful advances in recent years has been the use of high-frequency ultrasound. Ultrasound can often distinguish residual hyaluronic acid filler from scar tissue and helps guide the safest treatment plan.

You mentioned that you're hesitant to use hyaluronidase because you've seen friends experience adverse effects. While serious complications are uncommon when hyaluronidase is used appropriately by an experienced injector, I understand your concern. It's important to know that not every patient needs complete dissolution, and treatment should be individualized.

If you truly don't want additional hyaluronidase, your options become more limited:

If imaging shows only a small amount of residual filler and you're happy with the overall volume, observation may be reasonable.
If the filler is causing significant distortion, surgical removal of localized filler deposits is possible in selected cases, although this is less common and technically more challenging.
If most of what you're feeling is scar tissue rather than filler, dissolving enzymes won't help because they only break down hyaluronic acid.

Regarding fat transfer, I generally prefer that the lips be as close to their natural baseline as possible before grafting. Residual filler can make it difficult to judge how much fat is actually needed and may affect the final contour. For that reason, many surgeons recommend confirming that little or no filler remains before proceeding.

The good news is that you don't have to make this decision blindly. Imaging with ultrasound can provide valuable information and may help you avoid unnecessary treatment while giving you confidence about the next step.

Given your history of many years of filler, I would focus first on determining what is actually still in the lips before deciding between observation, selective dissolution, surgical correction, or fat grafting. That approach offers the best chance of achieving the natural appearance you're looking for.

Camille Cash, MD · Answer

If you have HA fillers you can either wait for them to be metabolized naturally or you can have the dissolved by injecting hyaluronidase.  Serious side effects from this enzyme are not common.  I encourage you to visit with an expert injector to discuss your concerns and learn more about your options.

Fillers won't go away, help!

Answers (3)

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