As it turns out, fillers are kind of like tattoos. (Kind of.)

When Courteney Cox mentioned in an interview last week that she dissolved all the fillers in her face, we had one major question: how? For the answer to that, The Lookbook turned to New York plastic Surgeon and RealSelf contributor Dr. David Shafer. He’s a national peer trainer for Botox and dermal fillers and he’s appeared on The Real Housewives of New York City. Every week in his practice, he has consultations with patients who want to remove the fillers they’ve gotten from another doctor.

“The vast majority of people that have fillers out there do look natural, do look normal,” he says. “It’s when you have some anomaly happen with somebody or they went to somebody who wasn’t trained very well. That’s when people get into trouble with it.” But luckily, some types of fillers can be reversed almost immediately. Confused? So were we, so we asked all our most pressing questions. Read on!

1. Wait, why does filler dissolve?

Hyaluronic acid filler (the kind that’s injected in cheeks or lips) is derived from a natural molecule you already have in your skin that provides hydration or moisture. “The only difference is in the laboratory they connect them by these chemical bonds, that’s what makes it stay in it shape while it’s in your body,” explains Dr. Shafer. “But over about eight months to two years, your body starts to metabolize it and break apart those bonds and then you just absorb it like you would your normal natural hyaluronic acid.”

2. How do you dissolve fillers on purpose?

Folks who don’t want to wait around for fillers to dissolve — like Courteney — can speed up the process. In the past four years or so, doctors have started to inject an enzyme that breaks the chemical bonds in the hyaluronic acid filler. “It’s breaking apart the gel under the skin and your body just absorbs it like it would your own natural hyaluronic acid that you normally have under your skin,” Dr. Shafer says.

3. What’s the process like?

Dissolving fillers happens fast: the enyzme is injected into where the filler is with a teeny, tiny needle. “It’s not a painful procedure,” says Dr. Shafer. “Usually patients say they feel a little bit of warmth or tingling in the area as the enzyme’s working.” He’ll often see a result right away, but it could take up to 24 hours to work completely. He then recommends that patients make another appointment two days after the injection for a reevaluation to see if they need a little more melting.

4. How much does it cost?

Dr. Shafer doesn’t charge his patients to dissolve fillers he’s injected, but the procedure starts at $400 per treatment for new patients.

5. Are there types of fillers that can’t be dissolved on command?

This enzyme only works on hyaluronic acid fillers. There are other types of fillers for different uses that can’t be immediately dissolved, including Radiesse (which is often used for injectable chin or cheek implants since it’s made of hydroxyapatite, what your bone is made out of) and Sculptra (which contains little particles that stimulate you to make your own collagen, so it’s often used for generalized filling). Radiesse lasts about a year to a year and a half, and Sculptra lasts two to three years.

“Sometimes I get patients, they don’t know what they had injected into them,” Dr. Shafer says. “They went to some clinic or they were in somebody’s living room — which I don’t understand why they would do that — but they get some injection and they come to me and they want to fix it and we don’t know what it is.” When that happens, he gives patients two choices: wait it out or try to inject the enzyme. “If it’s one of the other fillers or it’s unfortunately say like silicone or some off-market filler, it’s not going to melt it. You might have to have surgery, or you might have to do some other kind of treatments to camouflage the filler,” he says.

6. Even if fillers can be reversed, is it better to do your homework first?

In a word, yes. One way to research a reputable doctor or procedure is the RealSelf site for reviews and info. “It’s always better to get it right the first time, than to have to modify it or try to fix it later,” says Dr. Shafer,

But the process of overdoing procedures without realizing it that Courteney Cox described is absolutely a real phenomenon. “Fillers and Botox can make really nice changes for people, they just have to be done conservatively,” Dr. Shafer says. “Sometimes what happens, you get into a cycle like she did where you go to a doctor and they’re just trying to sell you something. They’ll tell you, ‘Oh, you need this and you need that,’ and another doctor will do it. The patient kind of loses perspective of reality, until it gets to be overdone. Or if all their friends in their peer group are doing the same thing, they all lose touch with what’s natural and what’s not natural. Part of my job is to be a gatekeeper. If it’s getting to be too much or not looking natural, I’m going to tell people no.”

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