After filler dissolving:
swelling, stages, warning signs and when to refill

Swelling, redness, itch and bruising: what is normal in the first 72 hours

Hyaluronidase is injected in a small amount of fluid through a fine needle, and the tissue reacts to both the injections and the enzyme. In the first 24 to 72 hours, these are expected:

• Swelling. The area can look puffier than before, at first because of the fluid that carries the enzyme and then from the reaction to the injections. It is often more noticeable on waking.
• Redness and small raised marks at the injection points, which fade.
• Itch or warmth where the enzyme was placed, usually mild and confined to the treated area.
• Bruising. Small bruises at the injection points are common and fade over the following days, changing from purple to yellow-green.
• Tenderness or firmness when the area is touched.
• An uneven look while the swelling settles at different rates on each side.

What these have in common is that they stay within the treated area and settle rather than worsen. Swelling or itching that spreads, hives, or redness and pain that increase after the first day or two are not part of normal aftercare; they are covered under warning signs below.

Day by day after filler dissolving

Everyone settles at a different pace, and the lips and the skin under the eyes tend to swell more than the cheeks, chin or jaw. As a rough guide:

Swipe sideways to see the whole table.

If a further dose is given at the review, the same pattern starts again from that dose. The written instructions you are given on the day take priority over this guide.

“Dissolving filler is not an undo button.”

Dr Sin YongOn what dissolving can and cannot do

Why the result is first assessed at about 48 hours

Hyaluronidase starts to break down hyaluronic acid soon after it is injected and keeps acting for a while afterwards. On the day, the fluid that carries the enzyme and the reaction to the injections add swelling, which can hide how much filler has gone or even make the area look fuller than before. By about 48 hours the enzyme has had time to act and the swelling has begun to settle, so what remains can be judged with more confidence. Any further dose is decided at this review and titrated to what remains (King 2018).

What happens at the review

• The area is examined at rest and in movement, and compared with the photographs taken before treatment.
• Where it helps, it is scanned again with ultrasound to show whether filler remains and where.
• You are asked about itch, swelling or any reaction since the injections.
• One of three things is then agreed: no further dose, a further small dose into what remains, or more time, because swelling still hides the result.

So the question of how long hyaluronidase takes to work is answered at the review, not in the mirror on the first evening.

How the area can look in stages

Dissolving rarely changes an area evenly or all at once. The swelling from the injections, the enzyme working through the filler, and the shape of the tissue underneath all show at different times.

Lips

On the first day, lips can look swollen, lumpy or lopsided, sometimes fuller than before the injections. Over the next days the swelling settles, often one side before the other, and the shape becomes clearer. Lips that have carried filler for a long time can look different from how you remember them before filler, and that is discussed at the review rather than judged on the first day. More on lips is in lip filler dissolving.

Under the eyes

The skin under the eyes is thin and swells easily, so puffiness in the first days can look like filler that is still there. The area is judged at the review, once that swelling has begun to settle; see under-eye filler dissolving.

Cheeks, chin, jaw and nose

Filler in these areas is often firmer, and hyaluronic acid products differ in how easily the enzyme breaks them down (Landau 2015). The change can therefore come in steps, sometimes over more than one dose, rather than all at once. See chin and jaw filler dissolving and nose filler dissolving.

Several areas, or a face that was overfilled

Where a lot of filler has built up, it is usually dissolved area by area, with a review between steps, so the face changes gradually and the balance between areas can be judged as it goes. See pillow face.

Aftercare: what helps and what to avoid

Aftercare after filler dissolving is mostly about leaving the area alone and giving the swelling time. Simple measures help. Follow the advice you were given, which takes priority over this list.

What helps

• A cool compress, wrapped in a clean cloth and held lightly against the area for short spells. Do not press hard, and do not put ice directly on the skin.
• Sleeping with your head raised on an extra pillow for the first nights, and not on the treated side.
• Keeping the injection points clean: rinse gently with lukewarm water and a mild cleanser, and pat dry.
• Photographs in the same light each day, if you want to follow the change, to bring to the review.
• Keeping your review appointment, even if the area already looks settled.

What to avoid

• Pressing, rubbing or massaging the area, unless you were told to.
• Heat for the first day or two: saunas, steam rooms, hot yoga and very hot showers on the face.
• Alcohol and hard exercise for the first day or two.
• Make-up over the injection points on the first day.
• Facials, facial massage, gua sha, at-home devices and energy-based treatments over the area until it has been reviewed.
• New filler in or near the area until refilling has been discussed, no sooner than two weeks.
• Starting a medicine or cream for itch or swelling without asking the clinic first.

If you are prone to cold sores and the lips were treated, let the clinic know if one starts.

Hyaluronidase side effects and warning signs

Most side effects of hyaluronidase are local and settle on their own:

• Swelling, redness, itch, tenderness or bruising at the injection points.
• An uneven look while the swelling settles.
• Breakdown of some of the skin's own hyaluronic acid near the injection site, which the body replaces.
• Over-correction: a hollow, if more filler is dissolved than was in excess (see below).
• Allergic reaction: uncommon, usually local swelling and itch, rarely more serious.
• Infection, which is uncommon after any injection.

Like any medical treatment, dissolving has its own risks and limits. These are the signs that need action.

Allergic reaction

An allergic reaction can begin soon after the injection or appear later, sometimes a day or more afterwards. Signs include swelling or itching that extends beyond the treated area or keeps increasing, and hives (raised, itchy welts) on the face or body. Contact the clinic straight away for any of these, or, if you cannot reach the clinic, see a doctor or go to A&E the same day. A systematic review of 37 studies describing 106 patients with hyaluronidase allergy found that previous hyaluronidase injections and sensitisation from insect or wasp stings were the main risk factors, that many reactions happened at a second injection, and that the reactions responded to treatment (Guliyeva 2024).

Allergic reaction: breathing difficulty, a tight throat, or swelling of the face, lips, tongue or throat that is spreading means calling 995 now. Call first, and let the clinic know afterwards.

Infection

Signs of infection include redness, warmth, pain or swelling that increases after the first day or two instead of settling, pus or discharge from an injection point, a lump that becomes red, hot or tender, and fever or feeling unwell. Contact the clinic the same day. A red, hot or tender lump is treated medically first. A lump that appears weeks or months after filler can also be a delayed inflammatory nodule, which needs medical assessment (Convery 2021).

A blocked blood vessel

These signs relate to filler rather than to the enzyme, but they apply whenever filler has been injected recently or is added again later.

Urgent: a change in vision or eye pain after filler means calling 995 or going to the nearest emergency department now. Skin that turns pale, dusky or mottled, or pain that is getting worse, needs urgent assessment by the doctor who injected you, or at A&E. See the warning signs of a blocked blood vessel after filler.

When a second dose is considered

A second dose is not decided on the day. It is considered at the review, once the first dose has had time to act and the swelling no longer hides the result, and only where filler you still want to reduce remains.

When it is considered

• Filler is still present, and the examination or scan shows where.
• The remaining filler, rather than swelling that is settling, is still what bothers you.
• There was no allergic reaction to the first dose.

When it is not

• The area already looks as intended, or swelling still makes it hard to judge.
• Any reaction to the first dose, even a mild one, has not yet been assessed.
• There are signs of infection.
• What remains is not hyaluronic acid, which the enzyme does not act on.

Hyaluronic acid products differ in how easily the enzyme breaks them down (Landau 2015), so firmer fillers, such as those used in the chin, jaw and cheeks, can need more of it, and guidance advises titrating to effect rather than giving a set number of units (King 2018; Murray 2021). Under ultrasound guidance, a further dose can be injected directly into the filler that remains (Schelke 2018). Because many allergic reactions happen at a second injection (Guliyeva 2024), tell the doctor about any itch, rash or swelling after the first dose before more is given.

If an area has not changed after dissolving, the filler may not be hyaluronic acid, or the enzyme may not have reached it; see when filler dissolving has not worked. For nodules large and small made of collagen stimulators, which cannot be dissolved, Dr Sin Yong uses the Sculpting mode of Time Freeze Laser LCLR®, without an incision; how each person responds varies.

If the area looks hollower than expected

Sometimes an area looks flatter or hollower once the swelling has gone. There are two common reasons. More filler may have been dissolved than was in excess, because the enzyme spreads a little within the tissue and breaks down any hyaluronic acid filler it reaches. Or the filler may have been hiding a hollow, loose skin or volume loss that is still there.

Small first doses placed into mapped filler, with a review before any more, are designed to lower the risk of over-correction. The enzyme can also break down some of the skin's own hyaluronic acid near the injection site, but the body replaces its own hyaluronic acid continuously, so this is not a lasting loss.

Judge a hollow once the swelling has settled, not in the first days, when swelling can hide it. If it is still there, the options are discussed then: leaving the area as it is, treating the skin, or a small amount of filler placed precisely, no sooner than two weeks after hyaluronidase (Murray 2021).

When can filler be added again?

Not on the same day, and not at the review. Published guidance recommends waiting at least two weeks after hyaluronidase, until the swelling has settled, before any refilling (Murray 2021). Until then, swelling can make an area look fuller or more even than it is, and filler added against that swelling can look different once it settles.

Whether to replace any filler is decided at that point, and sometimes the answer is to leave the area as it is. Where filler is wanted, it is usually planned as a smaller amount, placed precisely, and checked again once settled. If filler had built up over years, it is worth living with the new baseline for a while before deciding. Aftercare after new filler is set out in dermal filler aftercare.

How Dr Sin Yong follows up after filler dissolving

Dr Sin Yong performs the scan and places the enzyme himself, and he reviews the area himself at about 48 hours. You leave with written aftercare, which takes priority over this guide, and the clinic is your point of contact for questions in the days after treatment. The plan for what comes next, including the option of no further treatment, is set out in writing.

If you had filler dissolved elsewhere and are not sure whether what you see is normal, it can be assessed in the same way. How dissolving itself is planned is covered in filler dissolving in Singapore, and whether filler can simply be left to go on its own is covered in how to dissolve filler naturally.