Kalos [KĀYˈ-los]: The highest form of beauty and handsomeness with purity of heart and life; moral, noble
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Woman Checks Dermal Fillers in Mirror for Sign of Movement and Migration

“Filler migration” has been all the buzz on social media platforms like TikTok lately, with users claiming their cosmetic facial fillers have moved from their original location or created hard bumps beneath their skin. While social media may give the impression that filler migration is a common occurrence, it is, in fact, a very rare side effect. If you are considering fillers but are concerned about their safety, this post is for you.

What is filler migration?

Filler migration is the movement of a dermal filler from its injection site to another area of the body. While it is possible for fillers to migrate, this side effect is extremely rare and can be avoided by choosing a qualified injector.

Though filler migration is very uncommon, its likelihood increases when fillers are performed by an inexperienced or underqualified injector. With the increased popularity of facial fillers over the past decade, there have never been more clinics offering cosmetic injectables; however, this has led to an abundance of poorly trained, unprofessional practitioners performing injections.

What causes filler migration?

Here are a few causes of filler migration we have noted from treating patients who have had a bad filler experience:

Too much filler

We most often see this with patients who have had lip filler performed by an inexperienced injector. Adding too much filler at once can be too much for the lips to hold, and it can end up migrating up and out from the upper lip, creating the appearance of a “filler mustache,” or “duck lips.” We also see patients who have had too much filler added below their eyes, which can cause bumps to appear, since the skin in this area is exceptionally thin.

Injections performed too close together

An under-qualified practitioner may not space your filler injections out properly, potentially causing areas of the skin to be filled too quickly or too heavily. In order to optimize your filler results, an experienced surgeon will space your filler appointments a few weeks apart to allow your skin to “take in” your filler.

Too much handling

Unfortunately, there are a number of videos online providing post-filler instructions that may not apply to your specific treatment. Many of these videos recommend massaging your treatment area immediately following your injection—but this can be harmful. In some cases, we recommend our patients massage their fillers following treatment to smooth them out below the skin; however, too much massage too soon may cause the filler to migrate slightly. Touching your skin frequently right after your injection can also introduce bacteria to the tiny entry points left behind by the needle; these entry points heal quickly, but you should avoid touching them until the day after your treatment.

Wrong filler

Not all fillers are created equal, and understanding which fillers should be used to treat different skin concerns is a learned science. Below is an overview of the different types of dermal fillers and their intended uses:

  • Hyaluronic acid (HA) fillers like Juvederm® and Restylane® are made from the same HA that is produced naturally in the human body. HA fillers plump and hydrate skin and can treat acne scars, cheek depressions, marionette lines, and nasolabial folds. HA-based injectables are unique in that they can be dissolved with hyaluronidase , an enzyme that breaks down HA fillers.
  • At Kalos Medical Spa, we also offer the new Resilient Hyaluronic Acid (RHA®) collection of fillers for patients who want a “cleaner” filler to treat dynamic facial wrinkles and folds. RHA fillers require less processing than traditional HA fillers, making them more similar to the natural HA produced in our bodies. As a result, people tend to be less reactive to RHA, as the body perceives it as less foreign, and this helps RHAs last longer than most traditional HA fillers.
  • Calcium hydroxylapatite (CaHA) fillers like Radiesse® are made of a smooth gel containing calcium microbeads, which provide lasting volume to sagging tissues. Radiesse is ideal for filling in deep facial wrinkles and folds and adding volume to the cheeks. It is a thick filler, which should be placed deeper in the tissues for the best outcome.
  • Poly-L-lactic acid (PLLA) fillers like Sculptra® Aesthetic are perfect for addressing aging in your lower face, including laugh lines and deep nasolabial folds. Sculptra is also a very thick filler and is used to fill in sunken cheeks and treat deep lines and wrinkles. Unlike other fillers, it rebuilds a natural collagen framework within the body, creating thicker, more supple skin over time. Sculptra is also used to add volume to the buttocks and smooth crepey skin on the décolletage. The results from this filler are not immediate, and patients will require a series of treatments to achieve their desired results. However, once Sculptra treatments are complete, results can last for 2+ years.

Poor injection technique

It is important that your provider inject your filler in a controlled, gradual manner. Injecting filler too quickly can place excessive pressure on the treatment area, increasing its likelihood of migrating. It is also critical that your provider has a thorough understanding of the human anatomy and knows how deep to place your filler. For dermal fillers, the depth of injection depends on the volume and fat loss in a particular area, as well as the type of filler. Different fillers should be injected at different depths within the skin, and a poorly placed filler may create problems months later.

Though filler migration is very uncommon, its likelihood increases when fillers are performed by an inexperienced or underqualified injector.

Immune response

While some swelling is normal after receiving filler, a very small percentage of patients can experience moderate to severe swelling due to an immune system response triggered by an illness, allergic reaction, or vaccine. This swelling can very occasionally cause a filler to move slightly, though it is often only experienced in patients who had fillers placed within the past 6 to 12 months.

Though a severe immune system response to a filler is not related to the injector’s technique, it can often be avoided by undergoing a thorough patient intake screening. During this screening, a qualified injector will ask you about your complete medical history, including any medications you may be taking, any allergies you may have, and any vaccines you may have had or are planning on having (including the COVID-19 vaccine) to help determine whether or not you are at risk for a severe immune response.

Is there an area on the face where filler migration is more common?

When treating patients who have had poor filler treatments, we mostly see migration occur in the lips and under the eyes.

How can I tell if my fillers have migrated?

If your filler has migrated, you likely will not notice. This is because when filler migrates, it only does so very slightly (within a few millimeters) and rarely causes medical complications. But, if you see small lumps and/or raised skin around the treatment area, this may be an indication your filler has moved slightly or your skin has been overfilled.

It is important to remember that some localized swelling is expected after a filler treatment and should resolve on its own. We advise our patients to wait 2 weeks after their filler injection to allow time for any swelling to subside and for the filler to “settle” into the skin. That said, if you notice any severe swelling or bruising, contact your surgeon or medical provider immediately.

What do I do if my fillers migrate?

If you think your fillers have migrated or you have had a bad filler experience, Dr. Kirby and her injection professionals are able to use hyaluronidase to reverse HA-based fillers. If you are unsatisfied with your Radiesse or Sculptra Aesthetic results, her team can strategically add fillers or Botox® to improve the appearance of a poorly placed filler or an overfilled area.

Can I do anything to prevent my fillers from migrating?

Here are a few steps you can take to ensure you receive optimal results from your filler:

  • Choose a board certified plastic surgeon or dermatologist and follow her instructions precisely
  • Unless instructed otherwise, do not press on your treated area for a full day after your filler injection
  • Do not overexaggerate your facial movements; your normal facial movements will help smooth out your fillers and help them settle into place
  • Do not exercise the day you have your fillers placed

After your filler treatment, Dr. Kirby and her team will examine your results with you to determine if more filler is needed or not. At Kalos Medical Spa, we take a “less is more” approach to cosmetic injectables. If you’ve had HA filler injected by another provider in the past, Dr. Kirby may recommend dissolving it so that she can “start from scratch.”

Choose Kalos Medical Spa for your Fort Worth filler injections

To learn more about the uses of different dermal fillers and their safety, schedule a consultation with board certified female plastic surgeon Dr. Emily J. Kirby. Dr. Kirby and her skilled aesthetics team have extensive experience performing cosmetic injections to help men and women in the Fort Worth area age gracefully. Contact us online or call (817) 292-4200.