@chesnut.md: What I wish every patient knew about dissolving filler before surgery. This is why I remove filler BY HAND during surgery instead of dissolving it, and why that’s different than almost everyone else. The current norm in my field is to try to dissolve ALL filler before surgery. This usually includes multiple rounds of dissolution, sometimes 10+ (yes, 10) 😳 I do it differently👇🏼 We KNOW we cannot reliably dissolve all the filler before surgery. It’s an imperfect science, so imperfect that the industry has quietly reframed it from “dissolving” to “modifying” with hyaluronidase 🤔 Why so unreliable? The variables stack up: 
🔹 Different fillers dissolve at different rates
🔹 The age of the filler affects its dissolution 
🔹 The location it was placed and where it moved 
🔹 The dosage and accuracy of the hyaluronidase Ultrasound guidance can land the hyaluronidase in the right spot, but it does NOT change the biology of how hyaluronidase interacts with the filer once it gets there to “modify” it. Here’s my paradigm shift 🧠 When I remove filler manually during surgery, I SEE exactly what comes out - one for one. When I watch it come out, I KNOW it’s gone, there is no guessing. I’ve operated on many patients who had 10 rounds of dissolution and I STILL find filler in the tissue. So after I manually remove it, IF we need modifications (and that’s a real if), it’s often one round, maybe two - not ten. That brings up an important sub topic - hyaluronidase is NOT inert. I just co-wrote an article with @kelm_md my protégé, on how it affects fat cells, the fibroblasts that make your collagen and elastin, and blood vessel formation 🔬 Think of it like this: I’m not building a house on sand 🏠 I remove the filler I can see, build a solid substructure, and get the rejuvenation done right. It’s against the norm, but when you understand the WHY, it makes more sense to me. Have you been told you need multiple rounds of dissolution before surgery? Tell me in the comments 👇🏼 .
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#drchesnut #enigmalift #filler #fillerremoval #scarlesssurgery

Chesnut MD

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Sunday 13 September 2026 20:40:00 GMT