October 17, 2022

Dr Tim Pearce Consultation

If you are embarking on an elective lip filler reversal, the most important consideration is how you approach the consultation with your patient.

In this blog, Dr Tim Pearce will explain how the elective reversal process starts with a good consultation, including the pitfalls you might encounter that could land you in a difficult situation if you do not handle the communication correctly, or identify dysmorphic patients. He also discusses the importance of obtaining informed consent.

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.

How to consult different types of patients for elective filler reversal

Communication is key – remember the overzealous reverser and reversal-resistant patients we talked about in a previous blog about how patients feel about elective reversal.

During the consultation, you will need to speak differently to each of these types of patients to unpack their health beliefs and make sure that they understand the clinical need for the procedure and the potential side effects. You will also need to discount any falsehoods they believe around potential side effects from the reversal treatment.

Is the patient seeking lips filler reversal because they are body dysmorphic?

There is now a proliferation of Facebook groups which create considerable uncertainty and mistruths about what is involved with elective filler reversal procedures with hyaluronidase.

Dr Tim has noticed that such untruths have even made it into mainstream media with talk of how the enzyme can ‘dissolve your face’, for which there is no clinical evidence. Sadly, such groups perpetuate anxiety and dysmorphia over appearance.

Be aware of this phenomenon and understand that an early and thorough consultation (before treatment) is vital for identifying dysmorphic patients who can get into reversal cycles due to treatment dissatisfaction, which is linked to deep psychological discontent, that should be spotted and avoided by practitioners from the outset. Such patients will often move from clinic to clinic.

Is there a clinical need for filler reversal?

Aesthetic clinicians must look for a reason to reverse the dermal filler – the clinical need.

This means ensuring that there is either filler that is aesthetically displeasing, e.g., due to migration, or a complication like a lump, bump, or nodule.

If you can diagnose the clinical need, and the patient is prepared, you can move on to the next stage of the consultation.

hyaluronidaseEducating your patient about the elective filler reversal procedure

The greatest thing you can do to protect yourself, says Dr Tim, is to make sure that you have taught your patient the correct understanding of what the process of filler reversal involves.

How does hyaluronidase work?

Your patient needs to learn about how hyaluronidase works – it is an enzyme that breaks down polymer-type molecules made of carbohydrate (sugars). Dermal fillers are made of sugars, so the enzyme hydrolyses, adds a water molecule to the links or bonds between the sugars, and separates long chains into individual fragments which are then metabolised within the body.

The key is ensuring your patient understands that enzymes are highly specific in their mode of action, each with only one job, thus hyaluronidase will only dissolve the hyaluronic acid molecules and does not dissolve everything else in the face, such as collagen. Collagen is a protein and hyaluronidase only dissolves sugar molecules.

For more on this, read does hyaluronidase dissolve natural tissue and dissolve faces?

You must correct a patient if they believe this misinformation, and determine if they understand, or perpetuate their own flawed beliefs. You should refuse to treat a patient who continues to believe that you can dissolve other facial tissues like collagen with hyaluronidase.

Prepare the patient mentally for the hyaluronidase treatment

You must prepare your patient for the reversal experience using hyaluronidase, as part of the consultation discussion.

It can be difficult, psychologically, for a patient to ‘lose’ a treatment through reversal – worse case they may feel as if they have aged four or five years within 24 hours, as the enhancement is dramatically reversed.

Such a change can be significant for any patient but can certainly have a more triggering effect in a highly anxious or potentially dysmorphic patient. The work you put into explaining these consequences will reduce the risk of an adverse psychological impact on your patient.

You must help your patient accept that it is going to be a big change. They may have 1ml of dermal filler in their lip, for example, but once that disappears quickly, it can be somewhat disturbing as it looks and feels so different to them.

Avoid the temptation to mitigate the dramatic change by suggesting incremental treatment. This is not advisable as you can elicit an allergic response if you repeatedly expose patients to hyaluronidase.

Identify true body dysmorphic patients during the consultation

Body dysmorphic patients are overrepresented in the patient cohort who seek elective dermal filler reversal – they ‘ping-pong’ between treatment and reversal and have high dissatisfaction levels. If you have carried out a thorough consultation, it will be at this stage that you can identify such patients and refuse to treat.

Dr Tim Pearce has created a body dysmorphia and modification checklist that can help you if you are concerned about a patient.

Obtaining informed consent for elective filler reversal

Obtaining informed consent is about getting your patient to own the decision about going ahead with the procedure.

As the aesthetic clinician, you list the potential side effects and risks – allergic reaction, dissolving some natural hyaluronic acid (which will be replaced within a week), bruising and/or swelling from the procedure itself, and the small risk of infection as present with all injection-based procedures – plus recap on what is involved, the goal, and how hyaluronidase works. They must then agree that it is in their best interests to undertake the procedure, understanding those risks and uncertainties.

It is vital that you gain consent from your patient before proceeding with an elective lip filler reversal treatment. Dr Tim Pearce 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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