Dissolving filler in Newport News, with ultrasound to find it first.

Most dissolving is done blind. The injector forms a view about where the filler probably sits and injects hyaluronidase there. It often works. When it does not, it is usually because the filler was not where it was assumed to be.

We image the filler before we dissolve it. A high-frequency ultrasound shows where the filler is, how deep it sits and what runs around it, so the hyaluronidase goes where the filler is rather than where it is expected to be. The device is a Clarius L20, a high-frequency handheld ultrasound.

It also takes less hyaluronidase. Putting the enzyme where the filler is, instead of spreading it across the area, is one reason we prefer to dissolve under guidance. The clearest numbers come from emergency treatment of filler blocking a blood vessel. In a 2023 study of 39 patients, ultrasound-guided targeted injection used an average of about 123 units of hyaluronidase, against about 1,519 units for flooding the area — roughly a twelfth as much [1]. A 2025 review put the reduction at up to tenfold [2]. Two cautions. Those figures come from vascular emergencies, not routine dissolving. And in that study the guided treatment was given after flooding had not worked, so it is not a clean head-to-head comparison. We are not aware of an equivalent measurement for routine dissolving.

• Filler that has migrated. It is no longer where it was placed, so where it was injected is not a guide to where it is now.
• Lumps and nodules. Ultrasound distinguishes a filler deposit from swelling, from scar tissue, and from an inflammatory nodule. These have different treatments, and knowing which one you have comes before choosing.
• Filler someone else placed. You may not know what was used, how much, or how deep. Imaging shows where it sits now.
• Years of accumulated treatment. Repeated treatments can leave more filler in place than the history suggests. Imaging shows what is still there.
• Overfilled areas. Imaging shows where the excess sits, so dissolving can be aimed at it.
• Planning before new filler. Seeing what is already there comes before deciding what, if anything, to add.

Ultrasound images hyaluronic acid filler well. It images some other materials less well, and it cannot always identify which product was used.

Hyaluronidase only dissolves hyaluronic acid filler. Permanent and semi-permanent fillers — calcium hydroxylapatite, poly-L-lactic acid, PMMA, silicone — will not dissolve with it. If that is what you have, we will say so rather than treating anyway.

Dissolving is often staged. One session may not finish it, and a repeat session is priced by quote.

The diagnostic filler ultrasound is a scan and a second opinion without committing to treatment. It is $150, and if you book a treatment at that visit, the full $150 is credited toward it.

If you want new filler afterward, ultrasound guidance in the higher-risk areas carries no surcharge — see filler under ultrasound guidance. Filler itself is priced by the syringe on the dermal fillers page. Questions before you book? Contact us or call (757) 586-4575.

1. Schelke LW, Velthuis PJ, Decates T, et al. Ultrasound-guided targeted vs regional flooding: a comparative study for improving the clinical outcome in soft tissue filler vascular adverse event management. Aesthet Surg J. 2023;43(1):86–96. PubMed · doi:10.1093/asj/sjac227
2. Madero-Pérez J, Gil-Martinez M, Muñoz-Gonzalez C, et al. Guide for managing vascular occlusion caused by fillers with exclusive cutaneous involvement: a review of diagnosis, classification, and treatment. Aesthetic Plast Surg. 2025;50(5):2068–2082. PubMed · doi:10.1007/s00266-025-05104-3