Filler Removal Warning
A frequently asked question is whether it is possible to completely remove the filler from the injection site through surgery, and if there are any techniques or technologies available to completely eliminate filler from the body. It is regrettable to say that it is not as easy as many think, and complete removal may not be possible.
The Term "Filler" Does Not Specify the Substance
In reality, there are many types of fillers with different natures. "Filler" is a transliterated English word meaning a substance injected under the skin to fill or thicken a specific area; it does not specify the compound. It is like saying "food" without specifying what kind of food. Filler can refer to the patient's own fat, but the general public often thinks of synthetic substances. Synthetic fillers include **dissolvable types** such as **hyaluronic acid (HA)**, which is a compound naturally found in the human body, and **non-dissolvable types** which come in many brands and may not be naturally occurring human body compounds. All fillers are in a liquid state when injected. If removed within a few hours or days—whether by needle aspiration, a slightly larger incision, or injecting hyaluronidase (which only dissolves HA)—there is a higher chance of removal because it still retains its liquid form at the injection site. However, if left in the body for a long time, the situation changes entirely.
Once Injected, Filler Infiltrates Tissue and Cannot Be Fully Separated
If a long time has passed, there is no way to remove the filler completely without affecting normal tissue. Filler, in its initial liquid state, will disperse upon injection, often flowing to lower areas due to gravity (which is why we often see chins injected with filler looking saggy or pendulous) and infiltrating various parts of the body. Some fillers will no longer maintain a liquid state, but others with high internal cohesion can remain liquid for a long time. Once it has infiltrated the tissue, it is no longer easy to remove. This can be compared to gravy (filler) poured over noodles (tissue): over time, the gravy dries and adheres to the noodles. To surgically remove the filler, one must sacrifice the "noodles"—the surrounding tissue (such as muscle or nerves). Some people mistakenly believe there is a dissolving agent for all types of fillers; this understanding is incorrect. Only HA fillers have hyaluronidase available to dissolve them, but if the HA has infiltrated the tissue, hyaluronidase cannot help (and in fact, human tissue also contains HA, so injecting hyaluronidase dissolves both the HA in our tissue and the HA in the filler). However, if we do not remove it, we cannot predict what may happen in the future.
It Is Always Recognized as Foreign Material in Our Tissue
Regardless of the type of filler, the body views it as a foreign object and will respond in some manner. At a minimum, a process called "inflammation" will occur, followed by the creation of scar tissue (collagen) to encapsulate the foreign material. If the filler is similar to substances naturally found in the body and is dissolvable, there are usually no major problems. Even if the body responds with inflammation, it will be minimal, and because the filler does not remain for long, the inflammatory effects are not severe, and the injected person generally experiences no issues. However, if a non-dissolvable synthetic substance remains permanently in the body, the chance of problems increases significantly. The chronic, severe problems often seen in our society stem from non-dissolvable fillers that were not produced for human use.
Illegal Fillers Can Cause Organ Failure
Injecting fillers not manufactured for human use is both illegal and dangerous. These types of fillers are non-dissolvable and can cause severe and continuous inflammation, leading to permanent and serious tissue damage. It is hard to believe that people are still injecting liquid silicone today. If a large amount is injected and spread across multiple points (e.g., hundreds of cubic centimeters for breast enlargement), the filler and the resulting scar tissue from chronic inflammation will obstruct blood circulation. As the breast tissue continuously suffers from a lack of blood supply, it gradually dies and dissolves, but is simultaneously replaced by scar tissue. The breast size may not decrease, but it will become increasingly hard. If unfortunate, pathogens can enter beneath the skin, leading to severe infection and abscess formation. In the case of the breast, pathogens can enter through the nipple, which is the opening of the milk ducts connected to the internal mammary glands. If the condition reaches this stage, even if treated surgically, one should not expect that part of the body to return to its original normal state.
Conclusion
Once injected into the body, it is extremely difficult to remove filler completely. The highest chance for effective removal is within the first few days after injection; after that, once the filler has dispersed and infiltrated the tissue, the opportunity for complete removal is gone.