I talked about Botox a lot in 2025. Which, in the social circles of a 22-year-old woman, raises a fair question: why? We don’t have wrinkles yet. Our frontal lobes aren’t even finished developing. And yet, Botox and filler, procedures once reserved for red carpets and midlife crises, have become casual conversation, slipped between Pilates classes and oat-milk lattes.
Watching the normalization of injectables from inside the eye of the hurricane is… instructive. Listen, I’m a woman. I’ve heard it all. Be thin, but curvy. Blonde, but not too blonde. Long nails are in. No wait, cut them off! Short nails are chic again. In this late-capitalist hellscape, beauty standards change faster than it takes to say “Botox.”
There is a much larger story here about economics, insecurity, and the aesthetic arms race of Gen Z and millennials. But that is not my article to write. I am here — as we always are at the Office for Science and Society — to talk about the science.
Specifically, the idea many women are sold about filler: that it’s temporary, reversible, and low stakes. Like a tattoo you can laser off if you regret it. Don’t like how it looks? No problem, we’ll just dissolve it!
Now stop right there. If only it were that simple. Walk with me.
Filler 101: Not All Syringes Are Created Equal
Before we go any further, one thing needs to be said plainly: facial filler should only ever be injected by a licensed physician. Not a technician, not a “provider,” not someone who took a weekend course. And even then, simply holding an MD does not make someone qualified to inject or dissolve filler. That requires additional, specialized training and clinical experience to be able to properly deal with the face’s complex anatomy and the very real complications that can arise when things go wrong.
Now that we’ve gotten that disclaimer out of the way, let’s get to addressing the question that lies at the heart of this story; why get facial fillers?
Dermal fillers are used to add volume, smooth wrinkles, and reshape facial features. There are several types on the market, but only one underpins the comforting promise of reversibility: hyaluronic acid (HA).
HA is a molecule naturally found in your skin, joints, and connective tissue. Because of its biocompatibility, it has become the filler of choice for many. Other fillers, like calcium hydroxyapatite, poly-L-lactic acid (PLLA), and polymethyl methacrylate (PMMA), last longer and cannot be dissolved at all.
This distinction matters. Only HA fillers can be enzymatically broken down. Everything else? You’re in it for the long haul.
How Dissolving Filler Is Supposed to Work
HA fillers are dissolved using hyaluronidase, an enzyme that breaks down HA. Your body already produces hyaluronidase naturally, which is why in theory, the process sounds elegant and straightforward.
In reality, it’s neither.
Most of your body’s hyaluronidase activity occurs in the first two to four weeks after injection, when immune activity is highest. After that, enzyme levels drop. Filler integrates into surrounding tissue, and enzymatic access to it becomes limited. This is why dissolving filler months or years later is imprecise, and why many physicians recommend an “all-or-nothing” approach to dissolution rather than targeted correction.
And because hyaluronidase doesn’t distinguish between injected filler and your own HA, dissolving filler also means dissolving the structural HA that helps keep skin plump and supported.
Risks, Complications, and the Stuff Nobody Advertises
Dissolving filler carries many of the same risks as injecting it: pain, bruising, swelling, bleeding, and infection. Some patients report that the process of dissolving injections is more painful than that of getting the original filler.
More serious complications, though rare, are real. Vascular thrombosis, when filler blocks a blood vessel, can lead to skin necrosis and scarring. Involvement of ocular or intracranial arteries can result in blindness, paralysis, or life-threatening outcomes.
There’s also the issue of skin stretch. If filler has been providing volume for months or years, dissolving it can leave behind sagging or lax skin. Reversibility does not guarantee restoration.
The Myth of “It Dissolves on Its Own”
You’ll often hear that HA fillers last six to twelve months and then quietly disappear. However, imaging studies tell a different story.
has identified HA filler years after injection, sometimes more than a decade later, particularly around the eyes. Crosslinking and limited enzyme access mean persistence and migration are common, not exceptional. Temporary, it turns out, is not a calendar appointment.
When the Dissolver Becomes the Problem
Hyaluronidase is used off-label for cosmetic dissolution, meaning long-term safety data are limited. While many tolerate it well, there are increasing reports of severe adverse reactions: intense pain, accelerated facial aging, and significant psychological distress.
Estimates have been put as high as of patients experiencing adverse effects, with higher risk among those with longer filler histories and larger total volumes. Some clinicians now question whether natural HA levels fully recover in certain patients after aggressive dissolution.
As one surgeon bluntly put it in an interview with , the idea that filler “goes in and comes out without consequence” simply isn’t supported by reality.
Before the Needle, Know the Stakes
Fillers are medical procedures, not beauty accessories. And dissolving them isn’t necessarily an undo button.
Yes, HA fillers can be dissolved. However, it’s important to understand that this process is unpredictable, imperfect, and carries real risk.
In cosmetic medicine, reversibility isn’t a promise. It’s a probability. And one worth understanding before the needle ever comes out.
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Sophie Tseng Pellar recently graduated from şÚÁĎÍř±¬łÔąĎ with a Bachelor of Science (BSc) degree in the physiology program. She is continuing her graduate studies in the surgical and interventional sciences program at şÚÁĎÍř±¬łÔąĎ. Her research interests include exercise physiology, biomechanics and sports nutrition.
Part of the OSS mandate is to foster science communication and critical thinking in our students and the public. We hope you enjoy these pieces from our Student Contributors and welcome any feedback you may have!
