Hylase after hyaluronic acid fillers: when dissolving them may help – and where the limits lie
A filler result looks too full, a contour appears uneven or swelling lasts longer than expected: people considering having hyaluronic acid fillers dissolved usually want clarity above all. A consultation in Munich should therefore start with the question of what exactly is causing the change, before considering another injection.
Hyaluronidase can break down certain hyaluronic acid fillers. However, it is not a risk-free “undo button” and is not the right answer to every irregularity. The distinction between a planned aesthetic correction and an acute complication is crucial.
Acute warning signs take priority: If you experience visual disturbances, sudden paralysis or speech difficulties after a filler treatment, call 112 immediately. Unusually severe or increasing pain and noticeably pale, grey-blue or mottled skin require immediate medical assessment. Do not wait for a routine appointment or a reply by email. [2] [3]
What is Hylase, and how does hyaluronidase work?
“Hylase” is a medicine's brand name; its active ingredient is hyaluronidase. This enzyme breaks down hyaluronic acid, which occurs naturally in connective tissue and is also the basis of many injectable fillers. Hyaluronidase can therefore break down suitable filler material, but its action is not limited to artificially introduced hyaluronic acid. [1]
The authorised indication matters: according to its product information, HYLASE “Dessau” 150 I.U. is authorised for use together with certain local anaesthetics in the eye area. Dissolving aesthetic hyaluronic acid fillers is an off-label use of this product, meaning use outside its authorised indication. This prescription-only medicine requires an individual assessment of benefits and risks, along with an appropriate informed consent discussion. [1]
Not all swelling needs to be dissolved
After a filler injection, swelling, tenderness and bruising can initially affect the appearance. The immediately visible result is therefore not automatically the final one. Many common reactions settle within days to weeks; their course, location and severity vary. [3]
A slight asymmetry alone does not establish whether too much filler is present. An agreed follow-up assessment is more helpful than daily comparisons under changing lighting. It offers an opportunity to discuss which change actually bothers you, how long it has been present and whether it is improving or worsening.
Waiting must not mean ignoring new symptoms, however. Increasing redness, warmth, pain, fever or lumps that appear inflamed need prompt medical assessment. Delayed reactions are also possible. If there is an infection, simply dissolving the filler is not sufficient treatment; the product information warns against use in an infected area because the infection may spread. [1] [3]
When a planned correction may be considered
If an examination confirms an unwanted hyaluronic acid deposit, reducing it may be considered, for example if the volume or placement is unsuitable. This does not necessarily mean reversing the entire result. A small randomised study involving nine women showed that experimentally placed filler deposits could be reduced with hyaluronidase. [4]
However, this does not guarantee a correction accurate to the millimetre in the face: the study examined deposits in the upper arms, not the range of complications encountered in practice. It is therefore impossible to promise to “remove just this small bump and leave everything else unchanged”. [4]
A palpable lump is also a description, not yet a diagnosis. Before making a decision, it should be established whether filler material, an inflammatory reaction or something else is present. This is particularly important if the product and previous treatment have not been documented.
Why the material and treatment history matter
Hyaluronidase is not a universal antidote to all fillers. Other materials, such as calcium hydroxylapatite, poly-L-lactic acid or silicone, cannot be dissolved with it in the same way as hyaluronic acid. Some filler materials are difficult or impossible to remove completely. [3]
What does the assessment before dissolving fillers involve?
If you are considering a planned correction, it is worth bringing records of the original treatment. The more precisely the history is known, the more specifically the findings and desired change can be discussed:
- The product name and, if available, its product label or treatment report.
- The date, areas treated, quantities injected and any later follow-up treatments.
- When symptoms began and how they developed; photographs from before treatment and during the subsequent course.
- Medical conditions, medicines, known allergies, and whether you are pregnant or breastfeeding.
Depending on the findings, further diagnostic steps may form part of the examination. In specialist hands, ultrasound can help locate filler deposits and support targeted treatment. The publication cited here is a small case series, not a guarantee for every individual case. Whether such an examination is necessary and available must be clarified individually. [5]
Why several treatments are sometimes needed
Hyaluronic acid fillers differ in how they are manufactured and cross-linked. In a laboratory study, the nine products examined responded differently to hyaluronidase; exposure time and the amount of enzyme also influenced breakdown. Findings like these help explain differences, but they cannot be applied to an individual as fixed instructions for timing or quantity. [6]
The location and accessibility of a deposit also play a part in planning. For an aesthetic correction, a gradual approach with reassessment may be appropriate. A single treatment may therefore not be enough. Neither a reliable number of sessions nor an exact final result can be determined solely from the number of millilitres originally injected. [5] [6]
What are the risks and limits?
Hyaluronidase can cause local reactions and allergic reactions; severe reactions are also possible. Any previous reactions to hyaluronidase must be known before treatment. Proper use requires the ability to recognise and treat complications. [1] [7]
There is also aesthetic uncertainty: when volume is reduced, the result may differ from what was desired. The precision of partial dissolving is limited. A return to the original appearance cannot be reliably promised either. The available studies therefore do not replace an examination or an agreement on realistic goals. [4]
Planned correction or emergency: the crucial distinction
If filler enters a blood vessel, it can impair blood flow. This is a potentially serious complication, rather than ordinary dissatisfaction with the result. Warning signs can appear immediately or after a delay. The absence of severe pain does not reliably rule out impaired circulation. [2]
Suspected vascular occlusion requires immediate treatment by a suitably qualified professional. Hyaluronidase plays an important role in occlusions caused by hyaluronic acid; nevertheless, successful restoration of blood flow or prevention of lasting damage is not guaranteed. [2]
What to do: If you notice unusual skin discolouration or unusually severe or increasing pain, contact the treating provider immediately and explain that you suspect a complication. If immediate care by a suitably qualified professional is unavailable there, go to an emergency department without delay. For visual disturbances, neurological symptoms, difficulty breathing or circulatory collapse, call 112. Do not inject anything yourself, massage the area or experiment with home remedies. [1] [2] [3]
Dissolving hyaluronic acid fillers in Munich: questions for your consultation
Theresa Schleicher lists the correction of hyaluronic acid fillers with Hylase under other injectable treatments on her website. The practice is located at Arabellastraße 5 in Munich-Bogenhausen. [8] The following questions may help prepare for a planned consultation:
- What explains my findings, and how certain is this assessment?
- Is a correction already appropriate, or would a follow-up assessment be better first?
- What might improve with partial dissolving, and what cannot be reliably controlled?
- Which risks are relevant to my medical and treatment history?
- Who will carry out the treatment and follow-up assessment, and whom should I contact if I develop symptoms?
The decision may also be to defer treatment. A sound plan sets out the goal, possible alternatives and the limits of the correction before another injection takes place.
Further information: Hyaluronic acid fillers in Munich · Other injectable treatments · Fillers or skin boosters? For a non-urgent enquiry: Contact the practice.
This article provides general information and does not replace an individual examination or a personalised treatment recommendation. Acute warning signs require immediate medical help.
Medical sources
HYLASE “Dessau” 150 I.E. Product information, revised May 2026.
Authorised indication, active ingredient, contraindications, risks and prescription-only status.Murray G et al. Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion. J Clin Aesthet Dermatol. 2021;14(5):E61–E69.
Expert guidance on recognising and treating vascular occlusion; not a randomised study.U.S. Food and Drug Administration. Dermal Fillers (Soft Tissue Fillers).
Regulatory patient information on side effects and warning signs. US authorisation information does not apply to Germany.Alam M et al. Effectiveness of Low Doses of Hyaluronidase to Remove Hyaluronic Acid Filler Nodules: A Randomized Clinical Trial. JAMA Dermatol. 2018;154(7):765–772.
Small controlled study in nine women with experimental filler deposits in the upper arms; limited applicability to the face.Urso SU et al. Use of Minimal Amounts of Hyaluronidase in the Ultrasound-Guided Treatment of Acute Vascular Occlusion by Hyaluronic Acid: A Preliminary Report. Aesthet Surg J Open Forum. 2024;6:ojae025.
Small case series on ultrasound-guided treatment; does not establish overall superiority.Gerber PA et al. Time- and Dose-Dependent Effects of Hyaluronidase on the Degradation of Different Hyaluronan-Based Fillers In Vitro. Plast Reconstr Surg. 2023;151(3):560–567.
Laboratory study of differences between products; does not provide clinical dosage or timing instructions.Murray G et al. Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol. J Clin Aesthet Dermatol. 2021;14(8):E69–E75.
Supplementary specialist publication on safe use; bibliographic details and abstract available through PubMed.Theresa Schleicher. Other injectable treatments in Munich.
A source solely for the practice's published services and location, not evidence of effectiveness.
The statements are based on product information, regulatory information and specialist literature with varying levels of evidence. These do not establish a precisely predictable aesthetic result.
