Filler Migration Is Real, But It's Not As Common As TikTok Says It Is
If you’re into beauty and on social media, chances are you’ve run into at least one TikTok video or Instagram post on filler migration without even trying. With consumers starting aesthetic treatments earlier in life to stay ahead of the aging process—and to potentially prevent more invasive procedures down the line—more people are enchanting and changing their appearances than ever. On top of that, sharing results—the good and the bad—is possible with the click of a button on a smartphone, so you’re bound to see and hear a horror story or two out there while scrolling.
Meet Our Experts: Dr. Noëlle Sherber, M.D., F.A.A.D., Washington, D.C.-based board-certified dermatologist, co-founder of SHERBER+RAD, and clinical associate professor at George Washington University, Dr. Michael Horn, M.D., Chicago-based board-certified plastic surgeon
Before you fall down the rabbit hole of #fillermigration though, it’s important to understand why people get filler—lip filler in particular—in the first place. “Injectable dermal fillers are volumizing treatments,” says Dr. Noëlle Sherber, M.D., F.A.A.D., a Washington, D.C.-based board-certified dermatologist, co-founder of SHERBER+RAD, and clinical associate professor at George Washington University. “Patients seek out filler treatment either to restore volume that they've lost with time or to add volume to achieve a desired aesthetic result. Lip fillers add plumpness to the lips and can smooth and define the lip contour.”
According to Sherber, the most commonly injected fillers are made of hyaluronic acid. “While these fillers offer the safety benefit of being able to be dissolved by an injected enzyme, hyaluronidase, they can still cause problems if inadvertently injected into a blood vessel,” she says.
Filler migration is another unintended scenario that can occur, but it’s important to note that in the hands of an experienced professional, the chances of either are quite slim. Filler migration does happen though, so two pros weighed in here to help shed some light on what actually causes filler to migrate, how you can fix it, and more importantly, how you can avoid it in the first place.
What Is Filler Migration?
“Filler migration” is just a fancy way of saying that filler has moved from its designated or chosen spot to an adjacent area. “This is when dermal filler migrates from the injection site to another part of the face,” says Dr. Michael Horn, M.D., a Chicago-based board-certified plastic surgeon. “Though this typically occurs in central cheeks, lips, and tear troughs, it can occur anywhere filler is placed.” Dr. Sherber has even seen filler migration in the nasolabial folds as well.
That said, Dr. Horn is quick to note that filler migration is “rarer than the media and social media has portrayed it, especially when done by a board-certified plastic surgeon or dermatologist.” Dr. Sherber agrees, adding that migration happens a little more frequently with older generation fillers, which have a “slippery” texture, in her words.
“Newer fillers have updated their crosslinking technology to help them hold their shape while maintaining softness,” she says. This is precisely why you’ll want to consult a skilled professional prior to treatment to identify what filler is best for the tissue in the area where you’re being injected—and to be sure that they are using that and not something else.
What Causes Filler to Migrate?
Getting too much filler: A lighter touch with filler is often best to avoid a puffy, unnatural look, but also to prevent potential filler migration. “If an overabundance of filler is put into the lips, and it is more than they can hold, it can migrate out and create the look of ‘duck lips’ or a ‘filler mustache,’” says Dr. Horn. “If too much filler is placed beneath the eyes, bumps will result, as the skin beneath the eyes is quite thin.” Why exactly does this happen? “With filler treatment, if an area is overfilled, then there is tension in the tissue, and the soft gel will make its way out of the area with more pressure into an area of less pressure,” says Dr. Sherber.
Getting filler too frequently: Like other aesthetic treatments, maintenance can be important for keeping results, but you never want to over treat any areas of your face. In fact, filler appointments need to be spaced methodically. “If insufficient time isn’t allocated between filler appointments, areas of the skin can be filled too quickly,” says Dr. Horn. “An experienced injector knows the right amount of time to allow the skin to absorb filler.”
Handling the area too much: “Massaging the area too much or too aggressively post-injection can be detrimental,” says Dr. Horn. “If you touch your skin immediately after injections, bacteria can enter the small points made by the syringe, even though these heal quickly.” This can also cause migration to occur. “Mechanical manipulation of the area can cause small bumps, or nodules, to form, and could contribute to migration,” adds Dr. Sherber, so post-injection is not the time to break out the jade roller or gua sha stone. With the lips in particular, Dr. Sherber also advises against moving them more than you have to for those first few days post-filler treatment. “I advise my patients to avoid drinking through a straw for a few days (and, of course, they should avoid smoking), since repeatedly pursing the lips could cause the filler to move before it's well integrated with their tissues,” she says.
Getting the wrong filler: “Skilled injectors understand which brand of filler is most appropriate for each area of the face and would be least likely to migrate,” says Dr. Horn. “It is not a one size fits all approach when injecting filler into different facial regions.”
Getting the wrong layer of skin injected with filler: “The skin has three layers,” says Dr. Horn. “The deepest layer rests on the bone. If filler is injected into the wrong layer, it can cause it to migrate.” Again, this is why filler treatments are best left in the hands of highly skilled professionals that know what they’re doing.
How Long Does It Take For Filler To Migrate?
Even though the results of filler will be visible right away, migration can happen almost immediately, with a few days or weeks, or even up to years later in rare circumstances, depending on what the root cause of the issue is.
“If overfilling is the culprit, it will be noticeable almost immediately,” says Dr. Horn. “Elements like poor technique or filling a patient’s face without properly spacing appointments might become apparent in terms of migration. If a tear trough is injected too superficially, it can cause lymphatic obstruction and migration. This can occur years after the filler was placed.”
What Does Migrated Filler Look Like?
According to Dr. Sherber, filler migration tends to be most noticeable in thin-skinned areas, like under your eyes. “It can give the look of puffiness under the eyes after under eye filler or create a ‘filler mustache’ above the upper lip after lip filler,” says Dr. Sherber. Dr. Horn says migration can look like “pronounced fullness” in an area adjacent to where you desired volume in the first place. He also says bumps can occur underneath the eye, for example, if filler has migrated there.
In a certain subset of patients, Dr. Sherber says filler migration isn’t always a bad thing. “With more mature skin, sometimes migrated filler doesn't pose an aesthetic concern for the patient; for instance, it can augment volume around the lips to soften lip lines,” says Dr. Sherber. ”In younger skin, however, it can distort the facial features.”
Can You Fix Filler Migration?
Fillers aren’t permanent. So if migration does occur, the good news is you won’t be dealing with “duck lips” or bumps underneath your tear troughs forever. That said, you have a few different options for fixing migration.
“If you can live with the results, you can wait it out, and your body will naturally metabolize and break down the substance,” says Dr. Horn. “If the results of migration are too unsettling, the filler can be dissolved with hyaluronidase.”
An enzyme that breaks down hyaluronic acid gels, hyaluronidase can be injected to counteract any migrated hyaluronic acid-based fillers. This isn't a DIY situation though or something to be taken lightly. “A skilled doctor must dissolve the filler by injecting it into the correct area(s) to avoid other issues, such as creating a deficit in your volume of naturally occurring hyaluronic acid volume,” says Dr. Horn. It’s best to seek out a trusted dermatologist or plastic surgeon if you want to go this route for fixing filler migration.
You also might need multiple treatment sessions to get the area’s appearance back to normal, and you’ll have to wait for the area to fully heal before you can consider augmenting volume there with fillers again. “The area cannot be refilled immediately but can eventually be re-treated,” says Dr. Sherber.
Can Filler Migration Be Prevented?
It’s worth repeating yet another time because the stakes are high when it comes to your face: The best defense against filler migration is going to a trusted pro that’s very experienced with filler. “Seek out a board-certified plastic surgeon or dermatologist to perform filler injections,” says Dr. Horn. “Expert injectors understand that different types of filler are appropriate for various facial features and that some patients have more soft tissue and thinner skin.”
Even though individual aesthetic preferences can play a role in the injection process and desired end look, a “more is more is more” approach, clinically speaking, simply cannot be taken with filler for best results. “No matter how ‘full’ a patient wants to look, there’s a limit anatomically as to how much filler can safely be placed on one area,” says Dr. Horn. “Thin fillers cannot be used where thicker fillers would be more appropriate.”
Finally, in addition to not overfilling, proper cadence with treatments plays a role in migration prevention, too. “It's also important to keep in mind that the newer fillers last much longer than the products available years ago,” says Dr. Sherber. “When I see a patient come in reflexively at six months for a filler top-up, I often discourage them, as their prior filler would be expected to be largely still in place. Perception drift can occur, in which you get used to your new appearance after cosmetic treatment and think that you need more treatment or frequent re-treatment, so it's critically important to see an experienced injector who will say ‘no!’”
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