07/08/2026
This patient came in to have her filler dissolved.
Over the years, sheâd had multiple sessions of filler in her tear troughs, cheeks and chin. For the last couple of years, sheâd felt like her face looked constantly puffy. She hadnât gained weightâshe just felt swollen all the time.
When we scanned her face with ultrasound, we could see years of filler build-up. Dermal filler attracts and holds onto water, which is why her face had started to look persistently puffy.
The scan also showed something else: scar tissue.
A lot of people donât realise that filler is still a foreign substance. Although itâs designed to be biocompatible, your immune system still recognises it as something that doesnât naturally belong there. When filler sits in the tissues for years, the body can keep trying to deal with it, and over time that ongoing immune response can lead to fibrosis (scar tissue).
On ultrasound, fibrosis appears as bright white areas within the soft tissue. Bone is normally the brightest structure we see, so seeing multiple bright areas within the skin tells us something abnormal is thereâin this case, scar tissue around the filler.
Once the filler was dissolved, the volume that had been masking the scar tissue was gone, so the indentation became visible.
The dissolving didnât cause the dip. It simply revealed what had been there all along.
TREATMENT
The aim is to release the scar tissue.
We do this using hyalase together with a small amount of steroid to soften and release the fibrotic tissue, allowing the skin to settle more evenly and helping improve the indentation.
This patient had just one scar-release treatment alongside her routine Botox (which was not injected into the scar), and this was her result six months later.
Every patient is different. Some only need one treatment, while others need several sessions. It all depends on how much fibrosis is present, so treatment is always tailored to the individual.