Partial Filler Dissolution: Expert Guide to Micro Adjustments

For aesthetic practitioners, the ability to refine dermal filler results through micro dissolving represents an essential skill in delivering optimal patient outcomes.

While complete dissolution often feels like a safer, more predictable option, mastering the art of partial dissolution allows practitioners to make subtle adjustments that preserve desired results while addressing specific concerns.

Understanding Hyaluronidase Behavior

Before attempting micro dissolving, it’s crucial to understand the fundamental nature of hyaluronidase. This enzyme evolved to spread through tissues – think of bee venom’s dispersal mechanism – making precise, isolated treatment challenging. Unlike dermal filler, which we can place with relative precision, hyaluronidase wants to diffuse beyond its injection point.

This spreading characteristic creates both challenges and opportunities. While we can’t guarantee treatment will remain entirely localized, we can use specific techniques and careful dosing to minimize unwanted effects on surrounding filler. Understanding this fundamental behavior helps set realistic expectations for both practitioner and patient.

The Science of Precise Dosing

Understanding the relationship between hyaluronidase units and filler volume provides the foundation for successful micro dissolving. The baseline principle suggests that 100 international units of hyaluronidase will dissolve approximately one milliliter of dermal filler. However, this simple ratio becomes more complex when dealing with partial dissolution.

For example, when treating a lip where just two injection points need adjustment – equivalent to about 0.1ml of filler – you might use 0.1ml of hyaluronidase at a concentration of 1500 units in 15mls (or 100 units in 1ml). This concentration should theoretically dissolve only the targeted amount of filler.

Let’s break this down further: If you’re trying to dissolve what equates to two small injections in the upper lip (approximately 0.1ml), you would prepare your hyaluronidase at a concentration that matches this volume. Using a concentration of 1500 units in 15mls ensures that 0.1ml of solution contains exactly enough enzyme to dissolve 0.1ml of filler.

Practical Application in Lip Enhancement

Consider a common scenario: a patient presents with slight migration above the lip border or excess volume in specific areas. Your first task involves estimating how much filler you want to remove. You can do this either by visually assessing the volume or by recalling how much filler was initially placed in that area.

When treating migration above the lip border, focus your injection specifically in the area of diffusion, avoiding the desired filler placement within the red lip. This targeted approach helps maintain the aesthetic enhancement while addressing the migration concern.

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Patient-Specific Approach

Your treatment strategy might vary significantly depending on the patient’s circumstances and understanding of the process. With a patient who comprehends the possibility of needing touch-ups and accepts potential additional costs, you might take a more generous approach to ensure adequate dissolution.

However, when dealing with a more challenging patient – perhaps someone who’s had a difficult experience or is resistant to additional treatments – a more conservative initial approach might be warranted. While this might necessitate multiple sessions, it helps manage expectations and minimize potential dissatisfaction.

Technical Considerations

The choice between needle and cannula for dissolution often depends on the original placement technique. If the filler was initially placed with a cannula, using the same approach for dissolution can help ensure you’re targeting the correct plane. This matching of technique helps optimize the dissolution process while maintaining precision.

When selecting your entry point and injection depth, try to mirror the original treatment approach. This consistency helps ensure the hyaluronidase reaches the filler effectively while minimizing spread to unintended areas.

Managing Different Filler Ages

Old filler behaves differently from recently placed product. Filler that’s been in place for four or five years has typically already fragmented down, making it more susceptible to dissolution. In these cases, you might need significantly less hyaluronidase than you would for newer filler.

This variation in filler age requires adjusting your approach:

• For newer filler: Use standard dosing calculations
• For older filler: Consider reducing your initial dose
• For unknown filler age: Start conservatively and assess response

Concentration Calculations in Practice

Let’s examine a specific example of concentration calculation:

1. Standard concentration: 1500 units in 15mls
2. This equates to 100 units per ml
3. For treating 0.1ml of filler, use 0.1ml of solution
4. This delivers exactly the units needed for that volume

This precise matching of concentration to desired dissolution volume helps maintain treatment accuracy while minimizing unwanted spread.

Risk Management in Practice

Successful micro dissolving requires balancing effectiveness with safety. Consider these practical steps:

1. Document initial assessment thoroughly
2. Photograph from multiple angles
3. Mark precise injection points
4. Record concentrations used
5. Schedule appropriate follow-up

Patient Communication Strategies

Clear communication becomes especially important when dealing with partial dissolution. Explain to patients:

• The enzyme’s natural spreading behavior
• Potential need for multiple sessions
• Possibility of affecting surrounding filler
• Timeline for seeing results
• Options for touch-up treatments

Monitoring and Assessment Protocol

Develop a systematic approach to monitoring results:

1. Immediate post-treatment assessment
2. 24-hour follow-up when possible
3. One-week review
4. Documentation of changes
5. Planning for any adjustments needed

Building Your Expertise

Start with straightforward cases where:

• Filler placement is clearly visible
• Patient goals align with realistic outcomes
• Timeline allows for progressive treatment
• Patient understands the process fully

As your confidence grows, gradually take on more complex cases requiring precise adjustment.

Moving Forward with Confidence

Mastering micro dissolving represents an important advancement in your aesthetic practice. While the technique requires careful consideration and precise execution, the ability to make subtle adjustments enhances your capacity to deliver optimal patient outcomes.

Remember:

• Understand hyaluronidase behavior
• Calculate doses precisely
• Match injection techniques
• Communicate clearly
• Monitor carefully
• Document thoroughly

Elective Lip Reversal

 

Want to grow your confidence with dissolving filler treatments? 

Get Dr. Tim’s Elective Lip Reversal Training here. 

Designed to equip you with the knowledge, skills, and hands-on practice to master lip filler reversal and re-treatment with confidence.