When photos of Kylie Jenner at Paris Fashion Week started circulating online, people began to speculate that it was due to fillers. Critics on social media claimed her filler had aged her, with some describing her face as “a cautionary tale” about the aging potential of fillers. This review sparked a debate online about filler migration and whether it could lead to an aged or unnatural appearance.
Since the popularity of cheek, lip and jaw fillers, these treatments have emerged as a cornerstone of cosmetic surgery, offering people an option to contour, reshape and reduce the signs of aging without going under the knife. The fact that they are temporary just adds to the spirit of experimentation, giving one an option to improve and change without major consequences. However, comments about infill migration have sparked curiosity and concern. What really happens when the injectable filler doesn’t stay in place?
What is infill migration?
Filler migration refers to the movement of dermal filler from its original injection site to another area of the body. “Filler migration is actually a very rare phenomenon,” adds New York facial plastic surgeon Konstantin Vasyukevich, MD. “Hyaluronic acid fillers can only move within a short time after injection when pressure is applied to the area. Experienced injectors often take advantage of this effect and apply gentle pressure to “mold” the filler into the desired contour. After a few days, the filler will be incorporated into the surrounding tissue and cannot be moved — at least not by any significant amount.
Although migration of the filler is rare, it can occur due to various factors, such as injecting too much filler at once, injections that are done too close together, or improper placement of the injections. New York facial plastic surgeon Dilip D. Madnani, MD, says this phenomenon results from several factors. “Many factors can contribute, including patient anatomy, filler choice and injection technique. There is no single cause of migration.”
“Although it can happen anywhere on your face, it’s most noticeable in areas of the face where the skin is thin, like under the eyes or on the upper lip,” adds Palo Alto, Calif. facial plastic surgeon Sachin S. Parikh. , MD. “Filler can move in any direction depending on how and where the filler is placed. At the rim, we usually see it moving up.”
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The resolution of filler migration depends on various circumstances. While some cases may resolve spontaneously over time as the filler degrades and undergoes metabolic processes, others may require intervention. Dr. Parikh explains, “The active ingredient in fillers, hyaluronic acid, breaks down and is metabolized by the body over time. In some cases, doing nothing and letting the filler dissolve naturally is an option.”
How do you know if your filler has been migrated?
Locating filler migration is a challenge, particularly for those unfamiliar with the nuances of facial anatomy. If you suspect your filler has migrated, look for common indicators such as asymmetry, lumps or nodules, disproportionate fullness, and changes in facial contour. It’s best to consult a board-certified injector specialist who can assess the situation, explains Dr. Vasyukevich. “It’s not the filler itself that migrates. Rather, it is the resulting swelling that can give the impression of the wrong filler.”
Which fillers are most likely to migrate?
While filler migration can occur with any type of dermal filler, hyaluronic acid fillers are often scrutinized due to their hydrophilic properties, which can exacerbate swelling and displacement. Facial plastic surgeon David Lieberman, Palo Alto, CA, MD notes, “While migration of fillers is real, it is becoming increasingly rare as each new generation of dermal fillers comes out. As the cross-linking technology improves and the consistency becomes softer and more elastic, the fillers can retain their shape while maintaining the appropriate softness and texture. However, migration of the filler can occur when it is injected into the wrong tissue level. Migration can also occur when previously applied product draws water from the skin and appears differently as it takes up more space.”
How soon after filler can you see migration?
The onset of filler migration varies between individuals and depends on factors such as filler composition, injection technique, and tissue response. While some people may notice migration shortly after the procedure, others may experience a gradual progression of symptoms over time. Dr. Vasyukevich emphasizes the role of swelling in masking filler migration. “Swelling caused by filler placement can create the illusion of migration, which usually manifests itself in a downward trajectory,” he says.
How can you reverse it?
In cases of filler migration, rapid intervention is imperative. Dr. Madnani advises, “Dissolving the migrated filler before considering additional filler placement is paramount.” An injectable filler solvent called hyaluronidase can be used to reverse filler migration by enzymatically breaking down hyaluronic acid fillers.
However, it is important to note that some patients have experienced side effects such as burning pain, facial droop, and increased skin laxity, so it is important to consult a qualified physician.
Can you prevent it?
Although there is no surefire way to prevent filler migration, Dr. Vasyukevich emphasizes the importance of injector expertise. “Unfortunately, this problem cannot be completely eliminated, but the chances of it happening can be minimized. Injecting a moderate amount of filler in small increments, carefully monitoring the depth of injections, and recognizing early signs of ‘filler migration’ from previous injections can help limit this side effect.”
Dr. Lieberman adds that it’s all a matter of technique. “Precise placement in the targeted tissue layer helps minimize the risk of migration,” he says. “Also, injecting fillers in multiple layers allows the fillers to interact at different tissue levels, which provides more structure and contributes to a more natural appearance.”
