When it comes to one cosmetic procedure, Hollywood has had its fill.
With more and more people opening up about dissolving their facial fillers—see: Blac Chyna, Courteney Cox and Simon Cowell—looking natural has never been trendier. And we've all heard the horror stories of how filler completely altered someone's appearance, giving them a dreaded pufferfish finish. But removing filler, especially in that scenario, isn't exactly a black-or-white situation.
"It's not that filler is bad or filler is good, it's that if it's done tastefully and well, you shouldn't have any problems," board-certified facial plastic surgeon Dr. Ben Talei told E! News in an exclusive interview. "And if it's not, and you have problems, you can fix it."
Still, there are still a few catches.
For one, "when you fix it," the Beverly Hills-based doctor added, "you also have to realize that you might get problems because you might be doing too much fixing. Your face maybe got used to the stuff or maybe you got older." In other words, there's a chance your face will be droopier than before.
Additionally, not every type of filler is removable.
Hyaluronic acid-based fillers such as Juvéderm, Restylane, Voluma, Perlane and Belotero can be dissolved by using hyaluronidase (Vitrase)—which we'll talk about later. In turn, non-hyaluronic acid-based ones can't and these include, calcium hydroxylapatite (Radiesse), poly-L-lactic acid (Sculptra) and polymethylmethacrylate or PMMA (Bellafill).
Now that you have the bases covered, let's dive into cosmetic treatment that way you don't have to be on pins and needles any longer.
What is hyaluronidase and why is it used to dissolve filler?
First things first, hyaluronidase is an enzyme that breaks down the hyaluronic acid found in filler. According to Dr. Talei, it's one of the greatest tools available in the medical profession. But that's not to say it doesn't have flaws.
"The issue I have with it," the facial plastic surgeon pointed out, "is that doctors don't understand it well or how to use it artistically. But the same issue exists with filler and that's why you have the filler problem."
He said there's an art to "keeping the face less traumatized during dissolving," adding, "If somebody has 20 gallons of filler, you have to ask yourself, 'Do I really want to take it down to zero gallons or do I want to be gentle and take it to 18 or 15 gallons?'"
Moreover, there isn't a standardization on the amount of filler remover to use, which makes "people go nuts" with it, said Dr. Talei. He added that this leads to patients having to do more touch-ups that could've been avoided.
Why is there a rise in people dissolving their facial fillers?
Blac Chyna recently spoke out about being tired of not looking like herself due to filler. "It totally changed my face," she declared in a March 18 Instagram, "and I'm just ready to get back to Angela."
The reality TV star's reasoning has become commonplace, according to Dr. Talei. "The patients, the actors, the singers, they don't look like themselves anymore and it's because the face starts to act a bit differently with all this water in it," he shared. "So they get moon faces and balloon faces."
One potential cause of the puffy look is too frequent injections.
"People were treating fillers as though they were vitamins that lasted six months," Dr. Talei pointed out. "So they kept re-touching it, being really high-maintenance about it with the assumption that it goes away in six months."
When do people notice a difference after they dissolve filler?
The good news is that for anyone getting normal amounts of the injectable, meaning you haven't experienced the puffy fish look, "dissolvers work right away," according to Dr. Talei. "It can reverse them back to what they were."
Where it gets complicated is if a patient has been overfilled, if it's been in there for a long period of time and if they have more delicate tissues. If anything, removing it will only enhance the stretching that's occurred over the years.
As Dr. Talei put it, "They get very exaggerated deflation and look even worse when they get dissolved."
"That means that their face is slightly filler-dependent," he explained. "Their tissues have grown around it and their tissues require it to look normal at that point. They can never fully get rid of the filler nor should they."
But that's not to say there aren't any options.
In the event someone that's filler-dependent needs to dissolve it (they're having an allergic reaction, for instance), Dr. Talei said a doctor should still figure out how to refill the area so that the tissue looks healthy, adding, "The substances we have are either fat, Nano-fat or Sculptra."
How soon after getting fillers can you get them dissolved?
Dr. Talei recommends patients wait at least three weeks after getting filler before dissolving it. The biggest reason is that your face is still adjusting to the injectable and changing in appearance. "It may turn out perfect," he shared, "and the volume that you're seeing is not necessarily from the filler but from the swelling."
The other factor to consider is that you want the dissolver to be as controlled as possible. When you put dissolver in too early, "you're shooting it with a machine gun and it sprays everywhere," he highlighted. "So, the amount that gets removed is not as predictable. If you wait for everything to fully settle, and you need to dissolve anything, you can be much more precise with it like a sniper."
How much filler is a good amount to receive so you don't have to fix issues later?
While this might sound counterintuitive, filler should be subtle. "Some people see photos on Instagram where there are huge changes and they get inspired because they see what filler can do—not realizing the long-term consequences," Dr. Talei shared. "Ultimately, what happens is that the face accelerates in its aging, partially because of the fluid retention, which is stretching out the face and making it sag."
If there's one piece of advice Dr. Talei can leave readers with it's that filler isn't a cure-all.
"I know people want that, but it's not meant to give you perfection," he reminded. "It's meant for minor, incremental improvements to make the lip a little bit sexier, make the eyes look less tired, make the jaw look a bit cleaner. When you do it, do only what's needed."