Fixing Migrated Filler – Dissolving with Hyaluronidase
In recent years, we’ve seen an explosive trend in non-surgical cosmetic procedures incorporated into the average person’s beauty routine. Dermal fillers, in particular, have gained attention for their ability to change so many aspects of the face. Not all these changes that filler can do are done respecting an individual's anatomy and often do not to stay in a fixed position.
Dermal fillers work by injecting a substance, often Hyaluronic Acid (HA), into the skin to revitalize and restore its youthfulness. Fillers should be used to replace volume loss to specific features, such as the cheeks, under eyes, and lips. Fillers are currently popularized to create more volume in areas that do not need replacing in order to modify the face into a different shape or "lift" it.
Like all medical procedures, dermal fillers come with potential risks when not administered or cared for correctly; the most common is what is known as ‘migrated filler’. This term ‘migrated’ has caused people to believe that dermal fillers have a mind of their own and will continue to move away from the injection site. This is not true. There are several factors that play a role in pushing filler away from it's intended site of origin.
The other problem with Hyaluronic Acid (HA) dermal fillers are that they stay much longer in the body than originally thought. HA fillers are accepted by the body and are not broken down as quickly as anticipated. The lifespan of filler varies depending on the product used and cross-linking. We believe 1 syringe of cheek filler will last around 10 years.
Though they are rarely a health concern, displaced fillers are unattractive and concerning to clients who wake up one morning and realize that the beautiful volume from their dermal filler is not sitting in the place it was intended. Even more devastating is the person may have unknowingly overstretched their skin from too much filler as it accumulated over time under the dermis.
What does a migrated/displaced filler look like?
Filler displacement may happen subtly without realizing it. Bruising and swelling are common side effects of dermal fillers, however, if after two weeks you notice lumps above the treatment area or raised skin outside the treatment area, your filler may be displaced. If you feel like your filler is gone in a month or two- it probably has moved. If you can clearly see in photographs that your filler is no longer were it was even 6-12 months later there is a good likelihood it has migrated.
When it comes to lip augmentation, an early sign of filler displacement is discoloration around the vermillion border- the area surrounding the fleshy-colored part of the lips which separates them from the upper lips. As the filler migrates, you can see the corners of your mouth rounding out, and your lips lose shape as the filler migrates into the upper lip. The volume is stored not only in the pink part of the lip but the upper lip as well and often referred by clients as a "filler mustache".
When it comes to facial filler augmentation, you may feel like your face is more puffy or "you just don't look the same". Facial filler migration is more insidious and slow to the eye and the individual often has a hard time detecting it. They may appear "much older" for their age. Any facial filler done once a year for several years is high risk for migration.
What causes a filler to migrate?
In the medical cosmetic field, we are constantly learning new facts, adapting our approaches, and evolving our techniques. A displaced filler is often caused by the product selection, the experience of the Injector, choice of technique, and the amount of filler used. Additionally, migration is more likely to occur from high frequency local muscle movement, internal and external pressure and gravity. Some treatments like radiofrequency also can migrate fillers from heat and pressure.
At Skinfidelity, we are continuously researching and staying up to date with recent discoveries and news in the medical cosmetic industry. Like other experienced Injectors, the way we injected five years ago is not the way we inject today.
For example, ‘Russian Lips’ uses a tenting technique invoking direct punctures to the vermillion border. This tenting technique is currently the highest cause of lip filler migration. When a client feels her lips are getting thinner, many inexperienced Injectors ‘solve’ the issue by adding more filler. In reality, the existing filler has migrated or spread from the injection site and more filler is injected resulting in over-filling. Over-filling can lead to local tissue damage from stretching and premature wrinkling.
At our Clinic, we take the utmost precautions when selecting products for dermal fillers, as well as the techniques we use. Our unique experience and knowledge has taught us how to determine low-risk volumes to use to avoid over-filling and migration. Candidates are carefully selected or rejected. We use Hyaluronic Acid for our dermal fillers from the most reputable brands including Restylane. Our product selection is curated from the best results from clinical trials and the top reviews from patients world-wide when it comes to positive outcomes.
PreTreatment & Post Treatment care is essential
It isn’t always the Injector at fault. Pre Treatment instructions are given for a reason. Failure to follow can compromise the integrity of the injections and too much swelling or bleeding can displace the filler. During the first 72 hours of a dermal filler procedure, it is crucial that patients follow strict after-care measures such as avoiding putting pressure on the injected site, avoiding strenuous exercise, and alcohol consumption. We also recommend sleeping on your back for the first few nights. Careless aftercare can result in less than satisfactory results.
How can you fix a migrated/displaced filler?
If you do experience a displaced or migrated filler, there is a solution: dissolving the filler with Hyaluronidase.
Hyaluronidase is a soluble protein enzyme that is typically used to break down the Hyaluronic Acid (HA) found in dermal filler. The solution works by breaking down the bonds which hold HA together. Your skin will absorb these molecules in its own natural way.
There is a catch; the filler injected must be made of HA for this method to work. Secondly, administering Hyaluronidase is as much of a skill and art form as injecting dermal fillers themselves. It is crucial to seek treatment from a Cosmetic Injector who is skilled in this specific procedure.
Hyaluronidase is injected in précise amounts into the area where the dermal filler has migrated. It works very quickly once injected, with most of the effects taking place within 24 hours of the procedure. The results of dissolving may take 7 days to be completely visible.
The biggest risk to dissolving filler is allergic reaction. Although it is extremely rare, it can be life threatening. We carry epinephrine and have a protocol in emergency situations. We will do a small patch test first to monitor any potential sensitivity. Please find an experienced injector for this treatment.
Check out Skinfidelity’s TikTok page for informative videos on filler migration.