Non-Absorbable Fillers: Causes and Solutions

Hello.

I am Dr. Eui-Chul Jung, Director of SNU Plastic Surgery in Cheongdam.

In most cases, hyaluronic acid fillers

naturally absorb over time.

However, for some patients, the filler

remains unabsorbed even after several years,

causing discomfort.

Along with recent studies on this phenomenon,

we will explore the types and causes of non-absorbable fillers

and appropriate solutions.

⚠️ This article does not replace medical advice,

and those suffering from filler side effects

should visit a specialized medical institution.

# Why fillers don't absorb: Beyond simple ‘filler retention’

According to recent studies,

cross-linked hyaluronic acid fillers

do more than just physically remain; they

interact complexly with our body's tissues.

📍 Autologous Tissue Replacement Phenomenon

According to a Japanese study,

the space where hyaluronic acid filler is injected

acts as a kind of ‘mold’, so that

even if the filler gradually degrades over time,

new autologous tissue (the patient’s own skin tissue)

can take its place, maintaining some volume.

This is not due to the filler itself remaining undissolved,

but rather may be the result of a natural tissue regeneration process

induced by the filler.

📍 Diverse Cross-linking Technologies

Hyaluronic acid fillers

use different cross-linking technologies depending on the manufacturer,

which directly affects the filler's viscoelasticity, gel content, durability, etc.

Fillers made with certain technologies

are also developed with the goal of

longer lasting effects.

# Main types and cases of non-absorbable fillers

Fillers that cause absorption problems

are not due to a single cause but

can be divided into several types.

Please refer to the table below.

👉🏻 Removal and Solutions for Problematic Fillers

If problematic fillers are left untreated,

inflammation can worsen or

bone resorption can progress, so

it is important to consult a specialist.

# Hyaluronidase Injection: Dissolving Fillers

✅ Applicable to

Clumping, visibility, overfilling, nodules

caused by hyaluronic acid fillers

✅ Effects

The enzyme hyaluronidase

hydrolyzes and breaks down hyaluronic acid.

However, it may not be completely removed

with a single treatment or

may require multiple treatments,

and injecting under ultrasound guidance

allows for precise placement,

increasing removal efficiency.

In the case of hyaluronic acid fillers,

these dissolving enzymes make them

a reversible and safe material.

Therefore, for those considering filler procedures,

as a plastic surgeon, I recommend trying

hyaluronic acid fillers first.

# Surgical Removal

✅ Applicable to

Non-hyaluronic acid fillers that do not dissolve well with hyaluronidase

(such as Radiesse, Sculptra, Juvelook, Ellansé, etc.)

or unknown substances

(mainly procedures performed by non-medical professionals)

that have developed into foreign body granulomas.

✅ Surgical Method

Medical staff use ultrasound to

determine the exact location and

condition of the foreign body, then remove it with minimal incision,

minimizing damage to normal tissue.

Methods include non-incisional injection therapy,

non-incisional cannula procedures, extrusion procedures,

and incisional surgery, which are chosen based on the situation.

# Accurate Diagnosis and Specialist Consultation are Crucial

Just because a filler remains longer than expected

does not necessarily mean it’s a ‘side effect’; it

could be a natural tissue response of the body.

However, if accompanied by pain, inflammation, palpable lumps,

or aesthetic discomfort,

this is a sign that professional treatment is needed.

Self-treatment or neglect

can worsen the situation.

Always consult a board-certified plastic surgeon

for an accurate diagnosis and to discuss the safest

and most effective removal method

suitable for you.

If this article was helpful,

please share it with others who have similar concerns.

If you have any questions, please leave a comment😊

Thank you.

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