What To Do If You’re Considering Injectables & Worried About Filler Migration

Although social media’s emphasis on perfection can be held partially responsible for the growing popularity of cosmetic procedures, these platforms are also educating consumers to a much higher degree. Unprecedented access to what goes on in dermatologists’ treatment rooms and endless patient testimonials have trained the beauty community on what good results look like — and when to be concerned. This is particularly true for dermal filler procedures, as more horror stories about potential filler migration (meaning the filler has moved to the wrong area) have sparked a new hyper-awareness around the possible side effects.

“I have patients reach out to me and say they might have migrated filler and that never happened even two years ago,” says Tawnie Steiger, registered nurse and founder of Habitual Beauty Aesthetics . “My patients didn’t even know [filler migration] was a thing.” Ginille Brown, a cosmetic nurse practitioner, adds that “I’ve been injecting for nine years and I’ve seen [filler migration] the entire time. But now with social media being more prevalent, people are starting to realize, ‘Hey, it shouldn’t look like that.’ More people are deciding to do something about it.”

These stories may lead you to believe that injectables can freely roam virtually anywhere, but the reality is a little more assuring. “Filler isn’t sliding all the way from your cheeks to your chin, but people have that perception,” explains Brown. Dr. Tijion Esho, founder of Esho Clinic and ESHO lip products, says true filler migration is actually quite rare. “The face has fixed facial compartments and filler can only move where there is adjacent space,” he says. He adds that true spontaneous migration is usually a result of damaged or naturally weaker facial regions, like the undereyes, that can’t hold on to product as well, or an injector underestimating the potential space between the intended treatment area and surrounding tissue.

“What we’re actually seeing when people say ‘filler migration’ is filler that’s been misplaced in the first place. Poor injection placement and poor product choice is the majority of the reason we see this.”

What We Mean When We Say “Filler Migration”

The exact clinical presentation of filler migration is rare, but providers and patients alike have come to understand that the blanket term mainly refers to the undesirable symptoms of product in the wrong place — regardless of how it got there. “We see [misplaced or migrated filler] most often in high movement areas like the lips or the eyes,” says Brown. The lips may develop a “beak” or mustache appearance above the top lip or experience abnormal thickening from the filler settling in the wrong area that restricts natural movement. Under the eyes, filler may collect and form a jellybean-like mass. Other indications of filler issues may present as bluish bruises even after proper healing time. “This is called the Tyndall effect,” says Steiger. “Sometimes it happens when filler migrates or is placed too superficially under the skin, but it’s a fullness that you suddenly start feeling.”

What To Ask Your Provider If You’re Worried About Filler Migration

Why Is This Product Right For Me?

Avoiding problematic filler starts first and foremost with choosing the right provider. Injector skill level varies greatly and the rise of unqualified providers can put unsuspecting patients at risk. The experts encourage thorough research on behalf of the patient that prioritizes provider experience over price. “Primarily when I see things go wrong is when the choice for the treatment was based on price or it was an impulsive decision,” warns Dr. Esho. “A lot of people get angry because they don’t want to pay for the consultation. They know what they want and just want to book in, but many times they forget these are medical procedures.” Taking advantage of a consultation can be the difference between your desired result and the need for revisions later. “Your provider should be able to explain why they are choosing that product specifically for you and why they are choosing to administer a certain amount. The biggest problem is not being involved in your treatment planning,” says Brown.

Are My Desired Results Possible?

Another hallmark of a trustworthy injector is one that knows when to say no and recognize when the desired outcome is just not achievable. “Patients are always going to ask for more,” says Steiger. “People are often trying to achieve a fuller and fuller lip and it’s not realistic. If we attempt to do that, the filler will push outside of the natural lip border.” When your injector raises a red flag, it’s best to believe them. “I have some patients that tell me their other provider lets them come every two weeks, but at that time the filler isn’t fully integrated. I make all of my patients wait at least a month in between sessions when they are trying to add to the same area,” says Brown. “I want it to be integrated and I want to have fresh eyes on what you look like before we add.”

What Is The Proper Aftercare?

Once the treatment is finished, it’s still up to the patient to make the right choices at home for aftercare in order to avoid migration. Brown strongly warns against manipulating or massaging the treated area for the entire healing time which can be upwards of four weeks. “[The filler] is a gel and it can move if you're pressing on it,” she says. Sleeping on your face, receiving a facial, intense kissing, and pressing on swollen areas are all absolute no-gos for the first month of healing. Brown also advises those who wear tight masks for long periods of time, like healthcare workers, only get facial filler when they have considerable time off from work.

What To Do If You Experience Filler Migration

If you suspect your filler has migrated or was not injected properly, the experts recommend two options: seek out dissolution or wait it out as the filler naturally dissolves over time.

Getting Filler Dissolved

“When we dissolve filler, we use an enzyme called Hylenex that breaks down hyaluronic acid,” says Brown. “We inject it where there is unwanted filler, whether it’s migrated or improperly placed product, and it starts to soften immediately.”

Most providers dissolve their own work for free, but treatment deals or shady injectors may leave patients hanging. “Patients should consider what all they are paying for in the initial treatment. If it’s migrated, can you go back to that provider?” says Steiger. “There are some providers who will say it’s not migrated, don’t have the product on hand to dissolve it, or don’t know how to do it.” Both Brown and Steiger say you can expect to pay at least several hundred dollars to have filler dissolved with a new provider and full dissolution can take up to three sessions. Final cost and number of sessions required varies case by case but largely depends on how much filler is being dissolved, how long it’s been there, and the type of filler originally injected.

Metabolizing The Filler Naturally

On average, the body will naturally metabolize filler like Juvéderm and Restylane between six months to a year, but vestiges can linger for up to two years. A faster metabolism can speed up this process, but some fillers are manufactured to be more resilient and will take longer to naturally dissolve. “You can massage the area morning and night and use a hot compress to increase blood flow to the area. That can help the product break down naturally,” says Dr. Esho who prefers to use Hylenex sparingly. (The body’s natural replacement of hyaluronic acid slows with age, posing a potential risk for use of Hylenex in older clients).

Though studies are inconclusive on the enzyme’s effect on our natural levels of hyaluronic acid, Dr. Esho is wary about the reflexive decision to dissolve. “If these [techniques] fail over the course of at least six months, then discussions about Hylenex can be done.” Brown and Steiger, on the other hand, advise against holding onto unwanted or uncomfortable results. “If it looks off or is making you feel self conscious — I know it’s a hard pill for people to swallow, but you have to dissolve it,” says Brown. “I’d rather that than [a patient] feeling sad about this outcome we don’t like.”

It’s easy to label an injector as negligent if you’ve had a negative experience, but Steiger stresses that there are inherent risks to every treatment. “What’s important for people to understand is that this industry is still very young,” she says. (The FDA approved the first filler for lips in 2011.) “We are learning so much every year these products are on the market. [Migration] is something you should always see as a possibility if you’re going to engage in dermal fillers.” The real beauty of filler is you always have options. “Don’t try to be Dr. Google looking at social media and ruminating on images to self-diagnose,” says Dr. Esho. “[Your doctor] will give you reassurances and the right advice.”