October 31, 2022

We have looked at how to effectively consult and consent a patient for elective lip filler reversal and the types of patients who seek reversal treatment, including how they feel about elective lip filler reversal, alongside the indications for elective lip filler reversal.

In this blog, Dr Tim Pearce will discuss what happens if your patient comes back after elective lip filler reversal but is dissatisfied with the result, and you both agree that there is still filler in situ that requires dissolving. And, perhaps more importantly, who foots the bill?

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 long do you need to wait before performing a second elective lip filler reversal?

lip filler injection techniqueThe recommended waiting time before attempting a second reversal procedure is two weeks. This time frame is based on a generalised rule employed in medical aesthetics for safety.

Sometimes, however, a shorter time frame can be acceptable. If you see your patient ten days after the initial reversal procedure and there is clearly no difference in the quantity of filler remaining in place, i.e., it has not dissolved, then it would not be a particular risk to embark on a second procedure.

The critical factor is avoiding seeing a patient within 24-48 hours of the first procedure who presents with swelling and trauma from that procedure and may still have actively dissolving filler product and hyaluronidase within the tissue. You do not want to be treating this patient unnecessarily with a second reversal procedure, you should wait until you are certain that a second would be appropriate and, in the patient’s best interests.

Dr Tim would still recommend consulting patients that a two week wait between additional treatments is the best and safest course of action with elective lip reversal procedures.

Who pays for a second elective lip filler reversal if the first was unsuccessful?

The answer to this question will very much depend on what you explained to your patient during their consultation. If you are very upfront and explain that each reversal costs a certain amount, they should pay for subsequent reversal procedures.

If you forget to explain this in detail or give them the impression that they are paying for the result – the dissolution of all the filler – and not the steps it takes to get there, then you have made the classic mistake made by many aesthetic clinicians. The patient now believes they are paying one bill for the whole elective reversal and will not want to pay for subsequent procedures within that journey if required.

It is always a good idea to remind patients that they are paying for your expertise and time, and not for a particular result, as that cannot be guaranteed, but your time and services are still required.

How many times can an elective lip filler reversal be attempted?

Many clinicians want to know if there is a maximum number of times that you can attempt to reverse filler in a particular area. Dr Tim suggests asking yourself if you believe that you have injected enough hyaluronidase to fully dissolve all the product within the area.

If not, and you have injected a limited amount of hyaluronidase with the aim of dissolving part of the product (and problem), and doing so slowly, then it is reasonable to treat again.

If, however, you have injected the quantities of hyaluronidase that would dissolve much more filler than was present within the lip, (according to your clinical knowledge), and it has not worked, you should think about alternative diagnoses for the problem – oedema, non-hyaluronic acid based dermal filler etc. Similarly, evaluate if you injected into the incorrect tissue plane.

If you do not have a clear reason to re-inject and you have treated heavily the first time, Dr Tim recommends considering telling the patient that the diagnosis is incorrect, and they will not get a result from further application of hyaluronidase.

Hyaluronidase in sufficient quantities should remove all the hyaluronic acid within 24 hours. Any concept that you can gradually reduce the volume of filler over six procedures or over six weeks, for example, is not consistent with how hyaluronidase works.

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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