I won't dissolve other injectors' work...

Why I've stopped dissolving other injectors' filler (for cosmetic correction)

I will still dissolve in an emergency for anyone! Any time!

However.. I made this decision this week...

I've made a change in my practice and I want to explain the reasoning, because I think many of you will run into the same problem.

I no longer dissolve HA filler placed by other practitioners on an elective basis. I still dissolve my own work and my teams. And I will always treat complications, wherever the filler came from. That part is non-negotiable.

Here's what led me to this.

The pattern

I did a thorough consent process every time: what hyaluronidase can and can't do, the risk of losing native volume as well as filler, how the face may look once the product is gone, and the risks of the enzyme itself. Patients signed, and we proceeded.

According to guidelines - not reatment is an option today. BDD screened with a doctor. Consent from two practitioners... Photos. You get it..

Even so, I kept seeing the same four outcomes:

1. Volume shock. The patient understood the words in the consent conversation but not what the result would look like. Once the filler was gone, they saw their unfilled face for the first time in years and hated it.

2. Reversal. The patient absorbs something online, maybe a trend, an influencer, or a "filler is back" narrative, and now wants to go back to the overfilled look, sometimes asking for more than before.

3. Fixed migration beliefs. The patient is convinced the filler has travelled somewhere it hasn't, and every new sensation gets attributed to it. Dissolving doesn't resolve that belief. Often it just shifts the complaint somewhere else.

4. Hyaluronidase - "it eats your tissue".. The patient is convinced that there is permanent damage. even if consented properly.

   
   

What I've taken from this

A consent form records a conversation. It doesn't prove the patient understood it.

With another injector's work, I'm treating with incomplete information. I often don't know the product, the volume, the plane, the injection dates, or whether it has been partially dissolved before. Patient recall is unreliable, and ultrasound helps but doesn't answer everything.

Hyaluronidase isn't a benign eraser either. In our 2024 study of practitioner hyaluronidase use, we found wide variation in practice around concentration, skin testing, storage, and how adverse reactions are understood. 

There is also time lost. For your regular patients..I lose income

My mental health - it is a journey. That we have signed up for. But, it can be hard for us too.

Ultrasound - some patients request this.. It is not always believed!

Put it all together and the risk-benefit ratio for elective dissolving of someone else's work, in a patient whose expectations I can't fully read, often isn't there.

The psychological piece

Two of those three patterns, the reversal and the fixed migration belief, should make us think about body image concerns, including body dysmorphic disorder. BDD is over-represented in cosmetic settings, and procedures often don't improve symptoms (Higgins & Wysong, 2018). I'm not saying every patient who wants filler dissolved has BDD. Most don't. But a request to reverse a treatment deserves the same screening we would do before the original treatment, and arguably more.

What I do now

• Assess and document what I find, ultrasound included where relevant

• Give the patient an honest opinion on what I see

• Direct them back to the original injector wherever possible, since that person has the treatment records

• Recommend time before any elective decision

• Refer on where I have psychological concerns

  
  

• Treat any complication urgently, whoever's work it is

  
  

The trade-off I'm aware of

Saying no can push some patients towards someone who will dissolve on demand with less assessment. I don't think this approach is perfect. But I would rather send a patient away with a clear assessment and a plan than carry out an irreversible elective procedure I don't believe in.

I'd like to hear from you: do you dissolve other injectors' work, and what boundaries have you set? Tell me in the comments.

Mikey

References

Currie E, Granata B, Goodman G, et al. The use of hyaluronidase in aesthetic practice: a comparative study of practitioner usage in elective and emergency situations. Aesthet Surg J. 2024. doi:10.1093/asj/sjae009

Higgins S, Wysong A. Cosmetic surgery and body dysmorphic disorder – an update. Int J Womens Dermatol.2018;4(1):43–48.