The concept of “filler migration” has been all the buzz on social media platforms like TikTok lately, with users claiming their cosmetic fillers have shifted from their original location or have created hard bumps beneath their skin. While social media posts may give the impression that filler migration is an everyday occurrence, it is actually 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?

What exactly is filler migration? This is the movement of a dermal filler from its injection site to another, unintended area of the body. While it is possible for fillers to migrate, this side effect is extremely rare, and typically can be avoided by choosing a qualified injector, and following some simple steps we’ll lay out in this article.

Though filler migration is very uncommon, its likelihood does increase when filler treatments 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 injectables; however, this may have unintentionally led to an increase of poorly trained practitioners performing injections.

What causes filler migration?

Here are the most common causes of filler migration:

Too much filler

This is most often seen with patients who have had lip filler performed by an inexperienced injector. Adding too much filler all at once can be too much for the lips to hold, and it can end up migrating up and outwards from the upper lip, creating the appearance of a “filler mustache,” or even “duck lips.” This occurrence can also present when filler is added below their eyes, which can cause bumps to appear, as 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 targeted areas of the skin to be filled too quickly. In order to optimize your filler results, an experienced cosmetic physician will often 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 the specific treatment you have received. For instance, many of these videos recommend massaging your treatment area immediately following your injection – but this can actually be harmful. Only follow the post-treatment steps that your own physician provides you – don’t follow seemingly well-meaning but potentially dangerous online advice. Also, bear in mind that 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 do heal quickly, but you should still avoid touching them until the day after your treatment.

Wrong filler Used

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

• Hyaluronic acid (HA) fillers like Juvederm and Restylane are based around the same HA that is produced naturally in the human body. HA fillers plump and hydrate skin and can treat depressed acne scars, cheek depressions, marionette lines, nasolabial folds, and other conditions. HA-based fillers are unique in that they can be dissolved with hyaluronidase, an enzyme that breaks down HA fillers.
• Calcium hydroxylapatite (CaHA) fillers like Radiesse are made of a smooth gel containing calcium microbeads, which provide long-lasting volume to sagging skin tissue. Radiesse is ideal for filling in deep facial wrinkles and folds, and also adding volume to the cheeks. It is a thicker filler, which should be injected deeper in the tissues for the best outcome.
• Poly-L-lactic acid (PLLA) fillers such as Sculptra are perfect for addressing signing aging in your lower face, including laugh lines and deep nasolabial folds. Sculptra is also a very thick filler and is used to add volume to sunken cheeks and treat deep lines and wrinkles. But unlike most other fillers, it rebuilds a natural collagen framework within the body, creating thicker, more supple skin over time. Sculptra can also be used to add volume to the buttocks and smooth rough skin on the décolletage. The results from this filler are not immediate, and patients will require a series of treatments (usually three) to achieve their desired results. However, once all Sculptra treatments are complete, results can last for 2 or more years.

Poor injection technique

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

Immune response

While some minor 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 a vaccine. This swelling can very occasionally cause an injected filler to move slightly, though it is often only experienced in patients who had fillers placed within the more recent 6 to 12 months.

Though a severe immune system response to a filler is not directly related to the injector’s technique, it can often be avoided by undergoing a more thorough patient intake screening. During this consultation session, 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, 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, it’s been reported that migration occurs most often in the lips and under the eyes.

How can I tell if my fillers have migrated?

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

It is important to remember that some localized swelling is always normal to see after a filler treatment and should resolve on its own. It can take 2 weeks after a filler injection for any swelling to subside and for the filler to “settle” into the skin. However, if you notice any severe swelling or bruising in the immediate days following a dermal filler treatment, contact your medical provider immediately.

What do I do if my fillers migrate?

If you suspect your fillers have migrated or you have had a bad filler experience, your aesthetic medical practitioner can use hyaluronidase to reverse HA-based fillers. If you are unsatisfied with your Radiesse or Sculptra results, there are other approaches to mitigate this scenario. However, the injected filler cannot be dissolved with hyaluronidase.

Conclusion

Filler migration is very rare, but it can potentially ruin an otherwise pleasant cosmetic treatment.  Here are a few important steps you can take to ensure you receive the best results from your filler:

• Choose a board certified plastic surgeon or dermatologist and follow their instructions precisely
• Unless instructed otherwise, do not press on your treated area for a full day after your filler injection (even better, wait a few days)
• Do not overexaggerate your facial movements immediately after receiving treatment – your normal facial movements will help them settle into place
• Do not exercise the day you have your fillers placed – give yourself the day off