Correcting Another Injector’s Work
Correcting Another Injector’s Work: What You Can Know, What You Cannot, and What You Are Taking On
Revision work is now a substantial part of many aesthetic clinics. It is also the highest-risk consultation most injectors will do, because it begins with a face full of a product nobody can identify and ends with you as the last person who touched it.
Ten years of a maturing filler market has produced a predictable consequence: a large population of patients who have been treated repeatedly, in several clinics, with products they cannot name, and who now want it undone or improved. They arrive frustrated, often having already been dismissed once, and they are frequently very persuasive about what should happen next.
This is exactly the consultation to slow down. The clinical hazard is real, but the greater hazard is assuming the transfer of care also transfers the blame — it does not. Once you inject, dissolve or even reassure, the outcome becomes partly yours.
What you can establish, and what you are guessing
Patients report their treatment history with total confidence and considerable inaccuracy. It is worth being explicit with yourself about which parts of the history are evidence and which are assumption.
| What the patient tells you | What it actually establishes |
|---|---|
| “It was 1ml of a well-known brand.” | Almost nothing. Brand families contain products with very different cross-linking, G′ and longevity, and ‘1ml’ may describe the syringe, not the volume placed. |
| “It was hyaluronic acid, they said it dissolves.” | That they were told so. Poly-L-lactic acid, calcium hydroxylapatite, polycaprolactone, polyacrylamide, PMMA and liquid silicone have all been described to patients as ‘filler’. None of them respond to hyaluronidase. |
| “It was about two years ago.” | A rough interval only. Hyaluronic acid can persist far longer than its marketed duration, particularly in the midface, and patients routinely underestimate how many sessions they have had. |
| “Nothing has ever gone wrong before.” | That nothing was recognised or disclosed. Ask specifically about swelling episodes, antibiotics, steroids, lumps that came and went, and any previous dissolving. |
| “I’ve never had surgery or threads.” | Worth verifying by examination. Previous rhinoplasty, thread lifts, blepharoplasty and prior vascular events all change the risk profile and are frequently omitted. |
Get the records — and use the patient’s legal right to them
You have no right to another clinic’s records, but the patient does. Under UK GDPR and the Data Protection Act 2018 they can make a subject access request to any previous provider and receive a copy of their own record, normally free of charge and within one month.
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Ask them to do it, in writing, and tell them what to ask for: consultation notes, consent documentation, product names, batch numbers, volumes, sites and photographs.
Where the previous practitioner is contactable and the patient consents, a courteous direct request is often quicker. Frame it as a clinical handover, not an investigation — you will get more, and you will avoid a defensive response that helps nobody.
record that fact, record what enquiries were made, and consent the patient explicitly on the consequences — that you are proceeding without knowing what product is present, that this limits what you can predict, and that this uncertainty is a material part of the risk they are accepting. That paragraph in your notes is one of the most protective things you will ever write.
The assessment
Give revision consultations a longer appointment than a routine treatment, and treat the first visit as assessment only. Resist treating on the day.
- ✓
Full history
, including every clinic attended, approximate dates, areas, products if known, and any previous complication, infection, dental work, dermal filler dissolving or recent illness or vaccination. - ✓
Static and dynamic examination
in good light, seated upright and supine, with palpation of every area treated — and the areas the patient did not mention. - ✓
Standardised photography
before you do anything at all, in multiple views. This is not optional in revision work; you are documenting somebody else’s result, and it will be attributed to you the moment it changes. - ✓
An explicit written baseline
describing what you found, in your own words, including asymmetry, nodules, contour irregularity, skin changes and any signs of previous vascular compromise. - ✓
The patient’s actual goal
, tested against what is achievable. Many revision patients are seeking a face they had a decade ago rather than the removal of a product.
It is not all ‘too much filler’
The commonest error in revision consultations is to attribute every finding to over-treatment and reach for hyaluronidase. Work through a genuine differential:
- ✓
Over-correction or poor placement
— volume in the wrong plane or the wrong compartment, most often the midface and tear trough. - ✓
Product migration
— particularly perioral and infraorbital, often years after placement and unrelated to the original technique. - ✓
Chronic malar oedema
— lymphatic obstruction rather than product bulk. It may not improve, and can worsen, with further injection. - ✓
Delayed-onset nodules
— inflammatory, frequently triggered by infection, dental procedures or immune stimulation, and typically requiring antibiotic and anti-inflammatory management rather than immediate dissolving. - ✓
Infection or biofilm
— suspect it with fluctuance, recurrent episodes at the same site, or a nodule that responds transiently to steroid. Injecting into a biofilm can disseminate it. - ✓
Foreign body granuloma
— particularly with permanent and semi-permanent products. - ✓
Tyndall effect
— superficial placement, not excess volume. - ✓
Tissue descent and skin laxity
that filler never addressed and cannot address. - ✓
A non-filler cause entirely
— sinus disease, dental pathology, thyroid eye disease, allergy, autoimmune conditions and salivary gland problems all present to aesthetic clinics as ‘my filler has gone wrong’.
ask whether the finding is inflammatory. Hyaluronidase into an acutely infected or inflamed field is not a neutral act. Where infection is suspected, treat the infection first, take advice, and consider imaging and microbiology before enzymatic dissolution.
Imaging helps — but it does not name the product
High-frequency ultrasound has become genuinely useful in this work. It can demonstrate the presence, plane, depth and approximate volume of a deposit, distinguish an anechoic hyaluronic acid collection from a highly reflective or shadowing non-HA material, identify vascular structures before injection and guide targeted hyaluronidase.
What it cannot do is tell you the brand, the cross-linking, when it was placed or whether the patient will respond to a standard dose of hyaluronidase. Appearances overlap, operator experience matters enormously, and a confident ultrasound impression is still an impression. Use it to inform your plan, not to replace consent for uncertainty.
Permanent and semi-permanent fillers: stop
If the history, examination or imaging raises any suspicion of a non-biodegradable product — liquid silicone, polyacrylamide gel, PMMA microspheres — this is no longer a routine aesthetic case.
- Hyaluronidase will not remove it, and the treatment failure may be misread as needing repeated, escalating doses.
- Injecting anything on top of it, including hyaluronic acid, risks provoking a chronic inflammatory or granulomatous reaction.
- Management may require specialist medical treatment or surgical excision, and outcomes are often imperfect whatever is done.
- The appropriate step is referral to a practitioner or unit with specific experience in permanent filler complications — documented as such, with your reasoning.
Hyaluronidase: what it can and cannot do
Hyaluronidase is a prescription-only medicine. It must be prescribed for a named patient following a face-to-face assessment by an appropriate prescriber, and its use for dissolving dermal filler is off-label — which must be explained to the patient and recorded.
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A non-prescribing injector must have a genuine, arranged prescriber relationship in place
before
the day it is needed, not a phone number they hope will answer.
The consent conversation for dissolving is longer than for the original treatment, and should cover at least:
- ✓
That it works only on hyaluronic acid, and that if the product is not HA, nothing will happen. - ✓
That it also degrades the patient’s own hyaluronic acid in the treated tissue, and that a temporarily deflated, hollow or aged appearance is common in the following weeks. - ✓
That the result is not always predictable or symmetrical, and more than one session may be needed. - ✓
That some patients dislike the result more than the problem they came with, and that this outcome cannot be reversed — only re-treated later. - ✓
That allergic reactions, including anaphylaxis, are recognised. Resuscitation drugs, adrenaline, oxygen and trained staff must be immediately available, and the practitioner must be current in anaphylaxis management. - ✓
The interval before any new product may be placed, and that re-treatment is a separate decision at a separate appointment.
“I don’t know what product is in your face, and I can’t find out with certainty. That affects what I can promise you.”
“What I can tell you is what I can see and feel today, what I think is likely, and what I would do about it in stages.”
“If this is hyaluronic acid, dissolving should work — but it will also take away some of your own tissue support, and there is a period where you may look more hollow than you do now.”
“I’m not going to treat you today. I’d like to photograph you, write to your previous clinic for the records, and see you again in two weeks with a plan.”
Do not inject on top of what you cannot identify
The temptation in revision work is to camouflage: to add a small amount to balance an irregularity or soften a step. Where the underlying product is unknown, this converts an assessable problem into an unassessable one, and the mixture becomes yours to explain. If the plan is to add, be certain first about what is already there, or accept that you are working blind and consent accordingly.
The medicolegal position
Three principles are worth carrying into every revision case.
- You inherit the appearance, not the fault.
The moment you treat, any subsequent change is attributed to you. Your only protection is the baseline you documented before you started — photographs, description, and the limits you set out. - The patient who criticises their previous injector may well criticise you.
This is not a reason to refuse, but it is a reason to be exact about what you have and have not promised, and to keep the plan staged so that expectations are tested early. - Check your indemnity actually covers revision work
, including hyaluronidase, management of another practitioner’s complication, and any imaging you offer. Cover for ‘dermal fillers’ does not automatically extend to all of this.
Criticising a colleague
There is a difference between an honest clinical opinion and a disparaging one, and patients will actively invite the second. Regulators expect professionals not to make unjustified criticisms of colleagues — and equally expect them to act where patient safety is genuinely at risk.
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Both duties can be met at once.
“I can tell you what I’m finding today. I can’t tell you what happened at the time, because I wasn’t there and I don’t have the records.”
“This is a recognised outcome that can occur even when a treatment is performed correctly — which doesn’t make it acceptable to you, and we’ll deal with it.”
“If you want to raise a concern about the clinic that treated you, I can tell you who to contact, and I’ll provide a factual copy of my findings.”
Where you encounter something that suggests a real and continuing risk to patients — an unregistered injector, prescription-only medicines supplied without a prescription, treatment of a minor, or a pattern of serious complications — raising a concern with the appropriate regulator or authority is a professional duty, not an act of disloyalty. Record your reasoning, and keep it factual.
Charge for it
Practitioners routinely provide revision assessments free, from sympathy or from a wish to attract the case. It is a mistake. A properly conducted revision consultation is longer, more technically demanding and carries more risk than the treatment that caused the problem. Charging for assessment sets the correct expectation that this is medical care rather than a sales appointment, and it deters the small group who are touring clinics for free opinions to support a dispute.
Set out fees, staging and what a further session would cost in writing before treatment, and make clear that a correction is a treatment with its own risks and its own price — not a guarantee of a particular outcome.
A working protocol
- Longer appointment. Assessment only — no treatment on the first visit.
- Full history including every previous clinic, dates, products, complications and dental work.
- Examination static, dynamic and supine, with palpation of all areas.
- Standardised photographs before anything is touched.
- Ask the patient to request their records from previous providers; document the request.
- Form a differential — not a diagnosis of ‘too much filler’.
- Consider imaging where available and where it will change your plan.
- Exclude infection and inflammation before considering hyaluronidase.
- If non-biodegradable product is suspected, refer rather than treat.
- Prescriber assessment and a named-patient prescription for hyaluronidase; anaphylaxis kit checked and in date.
- Written consent covering the unknown product, off-label use, over-dissolution and the possibility of a worse cosmetic result.
- Treat in stages, review at defined intervals, and re-photograph at every visit.
- Record your reasoning at each decision point, not just the procedure.
PHP Training Academy teaches assessment, complication management and hyaluronidase use as core clinical content, not as an afterthought — from foundation through to advanced and Level 7 pathways. Talk to us about the right level for your scope of practice.
References and further reading
- Information Commissioner’s Office. Right of access (subject access requests) under the UK GDPR and Data Protection Act 2018.
ico.org.uk - Human Medicines Regulations 2012 (SI 2012/1916) — prescription-only medicines, prescribing and supply.
legislation.gov.uk - General Medical Council. Good medical practice (2024) and Guidance for doctors who offer cosmetic interventions — including duties on working with colleagues and raising concerns.
gmc-uk.org — cosmetic interventions - Nursing and Midwifery Council. The Code — professional standards of practice and behaviour.
nmc.org.uk — the Code - Joint Council for Cosmetic Practitioners (JCCP). Standards and guidance for practitioners, including complications and referral.
jccp.org.uk - Urdiales-Gálvez F, Delgado NE, Figueiredo V, et al. Treatment of soft tissue filler complications: expert consensus recommendations.
Aesthetic Plast Surg.
2018;42(2):498–510. - Aesthetic Complications Expert Group (ACE Group World). Consensus guidelines on the management of delayed-onset nodules, vascular occlusion and hyaluronidase use.
This article is intended for registered healthcare and aesthetic practitioners and is provided for education only. It is not clinical or legal advice and does not replace individual assessment, your regulator’s current guidance, the summary of product characteristics for any medicine used, or your indemnity provider’s policy terms. Hyaluronidase is a prescription-only medicine and its use for the dissolution of dermal filler is off-label. Practitioners remain responsible for working within their competence and scope of practice.
