Volume Loss
Hyaluronic acid fillers enhance the skin by increasing volume and plumpness. They do not only maintain the fullness of the lips but also help smooth fine lines. When one dissolves fillers with hyaluronidase, it breaks down the hyaluronic acid in the filler quickly and might affect the naturally occurring hyaluronic acid in the skin. That means that dissolving not only removes the injected filler but also causes the loss of the lips’ own hyaluronic acid, further contributing to reduced internal water reserves and volume support.
Hyaluronic acid has a strong capacity for water absorption, and it can hold more than 1000 times its weight in water. After the fillers are dissolved, this high capacity of water retention and locking is taken away, leaving the skin looking more deflated and flat. The volume loss in such a situation may be more pronounced in naturally thin lips or those individuals who do not have good skin hydration; the lips might even be more wrinkled since they are no longer supported by hyaluronic acid. In cosmetic dermatology, this is referred to as the syndrome of “Volume Effect Disappearance” and forms part of the more common side effects arising after dissolving fillers.
People who have used fillers for a very long period may find it difficult for the skin to adapt quickly to such a decrease in volume, and it becomes easy to immediately feel this noticeable “deflated feeling.” It is now understandable why some people may find that their lips do not look as anticipated post-dissolving.
Skin Support Loss
Fillers not only add volume but also serve as internal support. The firmness and support that skin receives from collagen and elastin fibers in the subcutaneous tissue are joined by fillers, forming an internal “frame” or “scaffold” in the skin, which can help improve elasticity and firmness. Once fillers are dissolved, the skin suddenly loses this “frame,” and the lips lose significant support, making the lip skin look saggy.
Anatomically, the skin of the lips is thinner compared to other parts of the face and has less subcutaneous fat. Hence, the support that the lips get depends almost entirely on the presence of collagen and hyaluronic acid. With aging, there is a gradual decrease in collagen and elastin fibers that can be replaced by fillers. When fillers dissolve, the skin without support sags, and wrinkles deepen.
Dermatological research shows that the body’s production of collagen reaches its peak in the early twenties and decreases yearly by approximately 1%-2% after age 25. Beginning around age 30, elastic fibers in the skin start to reduce by about 10-15%, which also refers to reduced repair and regeneration capabilities of the skin. Therefore, for older individuals, after dissolving fillers, the wrinkles and sagging feeling of the lips are more evident, especially when the natural elasticity of the skin is not sufficient.
Natural Aging Process
Fillers can temporarily conceal the signs of aging but are never able to reverse the natural aging process. With increasing age, it is inevitable to lose collagen, elastin fibers, and hyaluronic acid. Fillers work by adding volume and hydration to counteract this. When fillers are dissolved, these hidden wrinkles and signs of aging reappear quickly.
It has been estimated that the skin at age 40 contains only 50% of the hyaluronic acid compared to that at age 20, and by age 50 this further reduces to less than 30%. Therefore, in people who have used fillers for a long time to mask the effects of wrinkles, after dissolution of the fillers, the wrinkles and depressions in the lips could be more profound than before filling. This is medically termed the “Post-Dissolution Aging Rebound Effect,” caused by the sudden removal of support from the filler and the natural signs of aging being exposed.
Natural aging also involves a diffused lip contour, drooping lip corners, and less elastic skin. These natural manifestations of aging can be accentuated within a short period after fillers’ dissolution, with the lips looking more wrinkled and droopy than before.
Water Loss
Hyaluronic acid is a naturally occurring moisturizing factor in the body’s skin; it absorbs and locks in large amounts of water to keep it moist. In fillers, hyaluronic acid increases lip volume but also retains water that keeps the lips soft and smooth. When fillers dissolve, the skin loses this water-locking capability, with a sudden dramatic increase in water loss and thus drying of the lips with wrinkles.
Especially in an arid environment or without proper lip care, the amount of water loss is greater. It is said that hyaluronic acid retains more water than over 1,000 times its own weight, and the moisture content of the skin decreases by more than 40% without hyaluronic acid. After dissolution, the lips may lose a great amount of water in a very short period, which causes dryness, peeling, and even more fine lines. In those people whose skin lacks the capability of storing moisture, the wrinkles due to water loss will be more prominent.
Temporary Reaction to Hyaluronidase
Hyaluronidase is an enzyme capable of degrading hyaluronic acid. In the process, it degrades large molecules into smaller ones by damaging the molecular structure of hyaluronic acid to dissolve fillers. However, the enzyme may cause local inflammation in the process and further lead to mild swelling, redness, or itching. If the skin is sensitive, then hyaluronidase can cause a more noticeable localized reaction, thus inducing uneven wrinkles on the lips in the short term after dissolving.
Medical research indicates that 5%-10% of patients develop mild intolerance reactions to hyaluronidase, which include localized swelling and irregular wrinkles following the dissolving of fillers. It often disappears on its own in days or weeks, but sometimes it takes even longer to return to normal. If there is any allergic reaction to hyaluronidase in a patient, further anti-inflammatory or repair measures might include topical corticosteroid ointments to treat the area, cold compresses to reduce inflammation, or oral anti-allergy medications.
