October 10, 2022

botox fillers consult

More and more aesthetic clinicians are finding that patients are asking to have overfilled or incorrectly filled lips dissolved, known as elective filler reversal, performed using the enzyme hyaluronidase. This is a daunting prospect for those early in their aesthetic career and there are many aspects to consider, aside from the procedure itself.

In this blog, Dr Tim Pearce will discuss how patients feel about elective filler reversal and the different types of patients that practitioners will need to understand and manage through this process, including the overzealous reverser and reversal-resistant patients.

If you are unsure where to start with elective filler reversal treatment – how to effectively discuss it with your patients, carry out the procedure, including how much hyaluronidase to use, and when you can re-treat the lips, or if you are worried about whether you can legally correct someone else’s work, then sign up for Dr Tim Pearce’s elective lip reversal eLearning online course. It includes 15 in-depth learning modules and 5 bonus FAQ videos covering all the core knowledge and skills you will need to embark on elective lip filler reversal.

The types of patients who seek elective lip filler reversal

There are two types of patients that you might encounter when it comes to consultations and appointments for elective lip filler reversal.

The overzealous reverser

fish lip fillers overdoneThe overzealous reverser is often a patient who has just had a treatment and is in a panic due to over swelling, fearing that they have been over treated. They may contact the clinic the same day as their treatment, such as in the afternoon after a morning appointment, or the following day, and demand an immediate reversal.

You must ensure that you are understanding, but equally clinically mindful that it is usually swelling that is disturbing this type of patient, and the lip filler itself is not the problem.

Fear can make this patient incredibly forceful in their demands, and they will denounce the risks of immediate reversal, wanting it gone straight away. There may be social stigma at play too, in that they do not want anyone to know that they have had lip filler, or they have an important event coming up, thus swelling and certainly significant swelling is making them feel like they cannot get on with their lives, and they just want it gone.

As practitioners, we must understand their fears, their need to be heard and listened to, whilst persuading them that they do not need a reversal.

Similarly, this is a lesson in how to build that back into your consultation processes so that you can identify anxious patients who may have the potential to panic and educate them on what to expect, to avoid this outcome.

If patients are adequately warned to expect swelling, and by how much, during the consultation, before the treatment, they will normally manage the situation better.

This includes making it clear that you will not electively reverse the treatment due to swelling alone (separate to an allergic reaction or other complication) within the first 48 hours post treatment. The reason being that reversal causes more trauma and more swelling to the lip and would be an unnecessary medical procedure. It is important patients are aware of this as they need to know that the reversal process will not simply resolve their immediate concern, like a magic eraser, but will worsen the situation and is not medically necessary.

Reversal-resistant patients

A reversal-resistant patient is someone who clinically requires a lip filler reversal – due to overfilling, migration, past filler residue etc. – is informed of this fact yet refuses to go ahead with the procedure.

Whenever a patient is refusing clinical advice, it is important to listen to them and ‘unpack’ their reticence and the reasons behind their refusal of lip reversal. Often, you will discover that they have unfounded or ill-informed ideas about what is involved because they do not come from a medical background. Once you understand their concerns and fears, explain the facts, and rebut their understanding. Once they know the truth, you will often find that they change their mind.

Potential concerns they may raise include worries over wasting the filler from the original treatment (and the money they invested in it), yet they fail to realise that this filler has expanded the lip, is taking up more room that it should, and is ultimately downgrading their appearance with an overfilled look and a lack of definition to their vermillion border, especially if the lips are showing signs of filler migration. They should understand that you cannot save money with a treatment that does not look good, reversal and rebuild is the best option.

Others may be concerned that the reversal procedure is a ‘big deal’ and means that the treatment itself has gone badly wrong, yet it can simply be an unexpected side effect that occurs with some individuals, thus there is no real fault. Some practitioners also suffer from this worry, fearing they are at fault or will be admitting to ‘botching’ a patient, yet these things can just happen and are unintentional.

Consider ‘reframing’ the patient’s understanding of a reversal – this is not a sign of fault or someone doing something wrong – in fact, it is very normal for a patient who has regular filler treatments to experience a reversal at some point, especially with prolonged use over many years.

Ensure your patient understands exactly why you want to reverse their lip filler and neutralise any unfounded beliefs surrounding the reversal treatment. Elective filler reversal is part and parcel of managing a patient’s appearance if they are using hyaluronic acid-based dermal fillers.

It is vital that you gain consent from your patient before proceeding with an elective lip filler reversal treatment. Dr Tim has created a hyaluronidase consent form that you can download and use for free within your clinical practice.

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Lip Filler Treatment & Complications

With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.

If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.


Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

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