There are currently 23.9 million views for the #fillermigration hashtag on TikTok, so we're back to discuss another trending topic: filler migration. Migration is when the hyaluronic acid filler used in areas like the lips, for instance, moves from its intended injection site to create unnatural, obvious distortions to the face. Shelby Hall, a registered nurse known as @skinfidelity on the platform who debunks beauty myths and explains beauty dilemmas, has over 9.2 million views on her now-deleted video "Overfilled Lip Problems," which explains why too much product being injected can often a) have a shiny, flat surface to them and b) end up migrating. User Ruzannasmbatyan's video showcases exactly what it looks like when lip filler migrates; go down the list and you'll be served videos of people getting migrated filler dissolved to pointing out poor injection techniques.
This would scare anyone into believing filler migration is something that happens more often than not — especially if it's served up consistently on your For You page. "While social media may make it look like filler migration is common, it is actually a very rare occurrence," says Greenwich, Connecticut-based board-certified dermatologist Kim Nichols, MD. But it is happening and being shared in droves, so as a prolific boy band once asked, "tell me why?"
"What we are seeing in the market today is that the demand for these services is outweighing the supply, because patients are starting treatments at a much earlier age, and there are so many more patients asking for treatment than decades past," says Beverly Hills-based board-certified facial plastic surgeon Jason Diamond, MD. "In turn, we see more inexperienced injectors providing the service, so now filler migration has gone from a very rare risk to a trending discussion TikTok. The more refined the technique/specialty skill/acute aesthetic judgment, the less the occurrence."
- Kim Nichols, MD, a board-certified dermatologist based in Greenwich, Connecticut.
- Jason Diamond, MD, a board-certified facial plastic surgeon in Beverly Hills.
- Nancy Samolitis, MD, a board-certified dermatologist based in West Hollywood, California.
- David Shafer, MD, a board certified plastic surgeon based in New York City.
What Is Filler Migration?
"Filler migration, by definition, is the process of dermal fillers moving or migrating to areas other than their intended injection sites," says Dr. Diamond. Dermal fillers are minimally invasive injections that can be made from hyaluronic acid, calcium hydroxylapatite, or other ingredients, which minimize facial lines and plump the skin. Migration is mostly observed in areas like the lips, central cheek, and tear trough region, although it can happen anywhere you get injected with filler.
If you have filler, or are considering it, you may be eager to know whether or not certain fillers migrate versus other options. "Theoretically, all filler has the ability to migrate," says Dr. Diamond. "That is why it is so imperative that non-surgical injectable services are performed by experts with the anatomical knowledge to prevent this from happening. Prevention is the best medicine."
West Hollywood, California-based board-certified dermatologist, Nancy Samolitis, MD, noted that there's still research to be done on whether filler truly migrates, meaning it moves through the tissue, after injections. "Silicone particles from injection or ruptured implants have been reported to actually migrate through tissue, including through lymphatic to more distant locations, but this is much less commonly reported with hyaluronic acid and other common types of fillers," she says.
If there's fullness adjacent to the injection site, it could be a result of a variety of things, including improper injections technique – like injection too superficially too quickly — may cause the product to be introduced into the wrong tissue plane or into a lymphatic or blood vessel, says Dr. Samolitis.
"Usually, this is noticed immediately or within days of the injection," she says. "Other times, it seems that the properties of the filler or the appearance of the tissue can change gradually over time. This may be related to the filler breaking down partially or migrating more superficially due to muscle contractions, which is most commonly seen around the lips and undereye area. The area can become swollen and distorted gradually, even occurring years after the filler was initially placed."
Why Does Migration Happen?
One common thread when it comes to filler migration is that all of the sources interviewed for this story believe it boils down to the injector and their skill level. For Dr. Diamond, it's not just the technique, but judgment plays a huge role as well as overfilling the area can cause migration problems to develop, which ultimately boils down to how experienced your injector is. We recommend aesthetic treatments from board-certified dermatologists or plastic surgeons, which allow you to verify the longevity of their licenses online.
Dr. Nichols mentions that inexperienced injectors may put too much filler in during one session, or they may not space out sessions apart appropriately to let the filler before it is injected on top of the previous filler, or even their technique could be poor by injecting filler too quickly into an area. "Too much," she notes, depends on the patient's individual anatomy. Dr. Diamond backs this.
"There is no hard line-in-the-sand with the amount because of so many variables such as the specific facial feature's pre-existing size/shape/muscle composition/strength, etc. For example, a micro-droplet technique of filler placement is not going to migrate unlike techniques that deposit filler more quickly," says Dr. Diamond.
It can also be a plane issue, too — and we're not talking turbulence. "We have different tissue planes," says Dr. Samolitis. She explains that there are three layers to the skin: the epidermis, the dermis and the subcutaneous tissue, as well as fascia, which is on the bone. "Injecting the filler in the wrong layer can also cause the filler to (migrate). In some cases, too, it is just people putting filler on top of filler on top of filler, and then there's nowhere else for it to go. If the lip is already full of (filler), then it's going to flow through the path of least resistance and go a little above the lip."
The wrong type of filler is also an issue, according to all doctors interviewed for this story. "Every aesthetic injector has an arsenal of products with different composition properties and viscosities to use, and it is imperative they know what products to use and where to use them," says Dr. Diamond. "Each choice also comes with a different price tag, which is why I always tell my patients not to gamble with their face. I keep every filler readily available and know their properties front and back, so I can choose what is most appropriate for that patient's unique facial features." For instance, some patients have thinner skin than others; some patients have more soft tissue — all of these go into the decision-making process of what filler to use and how much of it is needed in his practice.
There are different viscosities of filler. According to Dr. Diamond, filler with a lower viscosity emulates a watery consistency, while higher viscosity fillers have more of a syrupy consistency. This gives the filler different lifting abilities. In medical terms, this is known as "G Prime."
"For example, fillers that have a higher G prime, like Restylane Lyft, have a texture that is thicker and creates more structure under the skin with more of a Jell-O-type consistency," explains Dr. Samolitis. "High G prime fillers are meant to be injected deep into the tissue, usually on top of the bone, to create lifting and volumizing of the cheeks, jawline, etc." She mentions fillers like Belotero and Juvéderm Volbella as having low G prime with a viscosity of slime and are appropriate for superficial areas like fine lines and the lips.
To that point, Dr. Diamond is seeing thin fillers used where thicker filler is more suitable and that more filler is used than is necessary. "There is an anatomical limit to how much filler is appropriate in each area, and when a provider goes beyond that, the filler can spread," Dr. Diamond says. "We also have to take into consideration the gravitational effect on the anatomical area we are injecting. If there is already going to be a gravitational pull on that injection site, such as the medial cheek, we need our treatment plan to account for that."
"An inexperienced or poorly-trained injector could use an inappropriate filler for the area being injected, such as using a robust thick filler like calcium hydroxylapatite (CaHA), which is indicated for use in deep wrinkles and folds of the face, but not appropriate for the thin skin of the lips or undereye area," says Dr. Nichols.
"I also think it's the type of filler (used) because Juvéderm Ultra and Ultra Plus are, I think, the most notorious for (migration) happening," says Dr. Samolitis. "I think it's just the property of the product itself. It's been around forever and a lot of people have a high comfort level with using it." She names fillers like Restylane Refyne, RHA, and even Volbella are products she tends to see less migration with.
While Dr. Samolitis notes Juvéderm Ultra and Ultra Plus seem to migrate more than other fillers she's practiced with, New York City-based board certified plastic surgeon David Shafer, MD, says that Juvéderm doesn't have any specific properties that would make it migrate more than other hyaluronic acid-based fillers.
Dr. Shafer, who is a paid trainer and spokesperson with Allergan Aesthetics — Juvéderm's parent company — says it's less about the product used and the amount being injected. "When areas are over filled such as the lips, there is often a capacity limit for filler. If more filler is added, it has to go somewhere," says Dr. Shafer. "Imagine filling a glass of water: at some point if you keep pouring water into the glass it will start to spill over the edges. The glass, just like the lips, has a limited capacity."
How Can You Tell If Your Filler Has Migrated?
Before you start overanalyzing your face, the biggest tipoff that your filler has migrated is that there's unnatural fullness in the area. "With lip filler, the upper lip border becomes less defined and a mound develops in the skin above the lip, causing the 'duck lip look,' says Dr. Nichols. "In cases of undereye filler, migration is seen as bumps in the lower eyelid and/or upper cheeks areas underneath the eyes."
Dr. Samolitis notes that there's a possibility it may not be filler migration, but more so swelling based on the type of product that was injected, which is why it's important to consult your injector if you notice anything isn't settling properly.
"Some fillers are more hydrophilic," Dr. Samolitis says, meaning it attracts water. "As the filler particles break down, their properties kind of change." She suggests that as the particles in the filler break down, there may be new opportunities for water absorption, so you may end up experiencing an edema (swelling) effect versus actual filler migration.
How Quickly Will You Notice Filler Migration?
Filler is the injectable we see immediate results from versus an injected substance like a neurotoxin, which inhibits the contraction of facial muscles and helps to smooth the skin and wrinkles, typically takes 10 to 14 days to see results. But identifying migration depends on what issue you had.
"If overfilling is the cause, it can appear fairly immediately," said Dr. Nichols. "However, if it's due to something like poor technique, or spacing sessions too close together, it can take months or even years to develop."
As noted, while this is rare, migration accumulating over time can cause potential health issues in the future. "Tear trough filler, for example, when injected too superficially, can migrate and cause lymphatic obstruction which can be present for years and years after the treatment date," shares Dr. Diamond. "It can cause a chronic and persistent problem that subjects a patient to explore remediation."
What Are the Options for Fixing Migrated Filler?
Before you run to get your filler dissolved — a process in which hyaluronidase, an enzyme that already exists in the body that absorbs the hyaluronic acid in the filler, is injected into the filler — take a deep breath and read this before making any gametime decisions.
However, if you do decide to opt to dissolve, it's imperative that the hyaluronidase is injected in the correct area or there could be long-term issues. "The enzyme should only be injected where the filler migration is present, because otherwise, it can lead to a deficit in your own, naturally-occurring hyaluronic acid volume," says Dr. Diamond. "I also want to point out that there are some instances where you cannot correct filler migration, such as liquid silicone injections. (Writer's note: This is not the same as hyaluronic acid dermal filler.) The liquid silicone encapsulates and can cause nodules and granulomas that oftentimes cannot be removed or corrected."
Should you get migrated filler dissolved, you may experience swelling. It's important to find an injector you trust — meaning they have ample experience, allow you to ask questions, and make you feel comfortable with the treatment plan — to figure out next steps. Dr. Nichols notes that patients shouldn't go filler happy if they want a realistic, natural result. "While studies looking into filler longevity are on-going, initial research has shown that remnants of fillers can persist in the body for years, especially in cases of initial over-filling," she says.
Dr. Samolitis understands it can be hard to do "homework" with injectors since the internet makes things more confusing. "There's all these certifications where people say, 'I'm a Certified Master Injector,' and it has zero meaning in the real world," she says. "And people (can) use fake photos. It could be really easy to get fooled by somebody who hasn't been doing it that long and doesn't have good training. The best thing you can do is ask lots of questions, because if they don't know, you're going to be able to know that they don't know."
What Happens If You Don't Treat Migrated Filler?
Dr. Nichols notes that because most fillers are semi-permanent, they will be metabolized and broken down; hyaluronic acid-based fillers for instance, take nine to 12 months on average to dissolve on their own. While it may not look great, lip filler migration, for instance, rarely leads to serious compilations.
Dr. Diamond agrees there isn't a health risk unless an immediate complication arises, for example, filler entering a blood vessel and causing an occlusion. "The body should absorb the HA with time, but that duration can be as little as a few months to over a few years," he says.
But filler could stay in the skin longer than anticipated, according to Dr. Samolitis. "We mostly evaluate filler longevity by studying the clinical appearance of the tissue, but now there are more studies using imaging techniques such as ultrasound to visualize filler inside of tissue," she says, indicating filler could be more permanent than indicated. "Luckily, filler migration causing serious side effects is incredibly rare as this has mostly been reported with silicone, which is much less of a popular option since we have safer treatments available. Usually, the complication is an unsightly cosmetic effect which can be reversed with injections of the HA dissolver known as hyaluronidase."
More info about common cosmetic procedures:
- The First FDA-Approved Injectable for Cellulite Is Here
- More Black People Are Getting Fillers and Botox Than Ever
- The Truth About Those "Temporary Nose Jobs"
Now, watch a dermatologist's entire routine:
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