Wait—Do We Need to Worry About Filler Migration Now? Expert Comments
Given the increasing number of patients receiving facial fillers in recent years, it’s no surprise that we’ve also seen an increase in “bad” fillers—horror stories about overcrowding of facial areas or filler migration (which is often and likely to be the same). Like any other topic that goes viral on social media, filler migration has spread to the rest of the internet.
But is it really as common as the 83 million posts on TikTok claim? In short: no. However, filler migration is always a possibility, so we asked board-certified plastic surgeon Jeffrey G. Lind II, MD, and registered nurse Vanessa Coppola, APN-C, FNP-BC, to discuss how to address the issue, recognize it, and resolve it if you experience it. Read on for full details on filler migration.
What is filler migration?
“Filler migration occurs when dermal fillers, commonly used in the lips, cheeks, and other areas of the face, migrate or move away from the intended injection site,” Lind concludes.
While many FDA-approved fillers are based on specially designed gel formulas that won’t move, external factors can get in the way.
How do you know a filler has migrated?
Depending on the severity of filler migration, it may be clearly visible to the naked eye. The most obvious case is usually the lips. “We see this most often in the perioral area, which is the area around the lips,” Coppola said. She explained that filler migrates from the red part of the lips to the surrounding area. “Sometimes you can identify this by the lips protruding from the contour, the red outline of the lip disappearing, and sometimes… filler migrates to the white cast on the skin.”
Detecting filler migration in other areas of the face can be more complicated—as Coppola explained, it’s a delicate art. “For example, in the tear trough area, this can sometimes cause filler to migrate to the surface of the skin and look almost like a Tootsie Roll, which is a discontinuous area of filler under the eye where the lower eyelid meets the cheek,” she explained.
Still, both experts noted that it’s important to schedule an appointment with an experienced healthcare provider to determine if your filler has indeed changed before jumping to conclusions.
What’s the cause?
There are a number of different factors (some natural, some not) that can cause filler migration.
Overfilling: First, experts note that overfilling an area of the face can cause filler material to migrate; generally speaking, technical errors are often the cause of migration issues. To avoid this, you should always work with a certified injector with experience in this field.
Injection Depth Error: Meanwhile, injecting filler material at the wrong depth can cause migration. “Having a very detailed and in-depth understanding of facial anatomy…is necessary to avoid adverse events such as aesthetic migration of filler material,” explains Coppola. “If filler is injected into an area with a lot of muscle activity, it can also cause the filler to migrate to the surface of the skin. We often see this in the tear trough area and on the lips.”
With all of that said, it should also be noted that migration can be caused by something as simple as repetitive muscle movement or overuse of filler. Experts note that repeatedly using filler in the same area over a long period of time can cause problems, as can the type of filler used and a person’s natural anatomical nuances.
How to Treat It?
If you notice filler migration and aren’t sure what to do next, don’t worry. You have a number of options—the first is to do nothing. If migration is neither cosmetically nor physically unpleasant, you can wait. Hyaluronic acid fillers typically dissolve after six months (some even after a year).
For those seeking an immediate solution, the second option is to dissolve the filler. “[Assuming it’s a hyaluronic acid-based filler] the injector can administer the filler with an injectable dissolving drug called hyaluronidase,” Lind explains. “However, this may require multiple sessions.”
It should be noted that dissolving fillers can be an uncomfortable process, depending on your pain tolerance. As someone who has had chin fillers dissolved once, I can personally attest that the feeling is not ideal, and I described it as a sharp, burning sensation. Nonetheless, the quick fix is undoubtedly worth it.
Can it be prevented?
Yes and no. There are some best practices that can help patients achieve the desired filler results. “You should always have an experienced injector perform the injection,” Lind emphasizes. “Injectors should avoid placing too much filler in one location, as it may spill into adjacent areas – the second most likely explanation for “filler migration” is the first being a poorly placed filler by the injector. Injectors must also use the correct filler to get the correct indication.”
Lind also noted that one should not sleep on their stomach for 48 hours after a filler treatment to avoid unwanted migration or distortion.
Notably, both of our experts told us that filler migration is uncommon, regardless of what you may see on social media. Following the above recommendations (along with proper aftercare) should generally result in a positive experience and positive results.
Final Verdict
“Soft tissue fillers are a great tool for facial rejuvenation when performed by an experienced injector,” Lind said. “Filler migration is probably much less common than what is reported on social media. Injection technique, errors in judgement, and technical errors are the most likely causes of what patients report as “filler migration.”
If you want to use fillers but are concerned about migration, our experts offer some advice: Do your homework. In addition to certifications, research the injector before using it. Do you have years of experience? Good reviews? Do you have before- and after-treatment photos of patients that you like? Ask for advice and don’t be afraid to ask questions.
