FILLER MIGRATION
Filler migration is something I do see in the aesthetic industry. Simply put, filler migration means that your fillers have moved or spread unintentionally. If your fillers have migrated, it will almost always be noticeable visually. This can be presented in many ways; for example in the lips it can vary from a shapeless, tubular/ducky upper lip, a shadow or mustache of filler above the lip, a lack of a defined borders, or bumps/tissue covering the teeth. Essentially it can create lumps or bumps that create notably misshapen lips and can prevent them from closing properly. In the eye area, this may present as chronic swollen or puffy eyes in the area where the filler once looked really good. We’ve all seen it and we’ve all heard about it.
This gorgeous friend and now patient came to me to after having lip fillers at another office over the last several years. After explaining that she was dealing with some migrated filler, she was on board with the plan to dissolve the old filler and start with a clean slate. If you ask any of my patients who have gone through this, they will tell you it is a process but the end result is worth it.
WHY Does FIller Move?
We don’t always know the exact cause but migration of the product over time does happen. This can be over years and years. We use facial expressions every day and these muscular contractions may play a role in displacing the fillers over time. Some products have a higher tendency to migrate than others. I see this happen to the most experienced injectors and have had this happen to my patients as well.
OLD FILLEr displacement
I recently had a patient from out of town who called me with under eye swelling. I did filler under her eyes over 5 years ago. She thought there was no way the filler was causing this issue. Once I evaluated her I told her I did believe it could be the old filler blocking the lymphatics and causing swelling. I used dissolvant under the eyes and VOILA! Her under eye swelling disappeared. This is not super common, but I just want patient’s to understand that it can happen and that is why it is important to go to an injector who can recognize and treat you should you need it.
Poor Filler Technique
Migration can happen when too much filler is placed in the lips so if I ever tell you that you do not need more filler it is because I have your best interest at heart! Our lips are little compartments and once they are at max capacity the filler has nowhere else to go than outside of the lip. An experienced injector will urge you to stop when they are full.
I cannot tell you how many times I have seen a patient who had filler done by a novice injector who used poor technique or the wrong filler selection, resulting in a botched filler result. I recently helped a friend of my sister’s with a filler complication. She didn’t want to wait a few months to see me in the office so she saw a novice injector who left bumps on her lips that were covering her teeth as well as placed botox in a muscle it should not be placed in, making her smile crooked…worst part is…this was the week before her wedding. I brought her in 4 days before her wedding to dissolve the filler because we both agreed that she would be better off with a little bruising that could cover with makeup than the filler hiding her teeth in her wedding photos. I don’t share these stories to scare anyone, I just want people to understand that filler is a medical procedure and it should not be taken lightly. It takes YEARS of experience to refine injection technique. If an injector has a wait or is not the cheapest in town…that’s a good thing.
HOW DO I KNOW IF MY FILLER NEEDS TO BE DISSOLVED?
Sometimes a patient may not realize their filler has migrated, but an experienced provider can help guide you. Typically we see a thickened/mustache appearance above the lip where the filler has moved beyond the vermillion border. You can also have filler beyond the wet to dry border in the wet lip and this can cause the lip to hang low and cover too much of your teeth. If you are thinking your filler needs to be dissolved, it just might need to be. Any experienced injector will be able to recognize when filler should be dissolved, so if you are unsure – just ask!
EMERGENCY FILLER DISSOLVING
If filler is accidentally injected into an artery, it can block the artery. This phenomenon is known as vascular occlusion. You immediately will want to have hyaluronidase injected to dissolve the filler, take some aspirin, apply nitro paste, and use warm compresses. Hyperbaric oxygen is also effective in bringing blood supply to the affected area. The key for this treatment is early identification and many new injectors are not always able to diagnose this early on. If you have SEVERE bruising, blistering, or pain you need to seek immediate attention and notify your injector right away. Again, this is why you want to put your beautiful face in the trusted hands of an experienced injector. No groupon shopping!
KNOW YOUR FILLER
Hyaluronic Acid Filler
If you are my patient, you should know that I only work with HA fillers. Hyaluronic acid is a naturally occurring carbohydrate in the body- making it very safe and is also completely reversible. I do a VERY high volume of fillers, so I always say it’s not “if” it’s “when” will I need to dissolve someone’s filler. I want to have the ability to correct filler when it needs to be corrected or reverse a complication should one arise. This is why I only work with HA fillers that are reversible.
Filler that has migrated into the wrong plane may never dissolve on its own and will likely need to be dissolved. I see filler last much longer (years longer) than it’s expected to, so if you have filler in unwanted areas I would recommend dissolving and starting over.
WHAT IS THE DISSOLVING PROTOCOL?
I use hyaluronidiase, which is an enzyme that targets the hyaluronic acid filler. Once this is injected into the filler it can take up to one week to fully dissolve. Sometimes more than one dissolving session is needed. Then, we wait at least 2 weeks to allow time for the tissue to heal before re-injecting the lips again. It is important to wait this 2-4 week period before re-injecting with filler. This allows any inflammation to subside and for the tissue to completely heal so that the new filler will look its very best. I know it’s hard, but wait it out!
Dissolving filler costs start around $500. The medication is expensive and it requires a lot of time and care by your provider. If one of my patient’s has a complication I will of course dissolve the filler at no charge, but if you are coming to me from another injector and need your filler dissolved the fee can add up. I always advise that if the patient has a good relationship with their former injector that they go there and see if they will dissolve the filler complimentary first. Then wait and come to see me. Oftentimes, the patient does not feel comfortable or safe going to the previous place and in those cases I am happy to take the patient on and do the dissolving.
Remember this…
Groupon lips deal $400
Dissolval $500
Refilling with experienced provider $700+
The Groupon deal sounds good but more times than not costs you twice as much!
XO
Racquel
