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Filler Migration. When Is It Time To Start Fresh?

By Jill Charles, MSN, CNP

We have all seen it, the filler mustache! When lip filler migrates beyond the vermillion border, it is never a good look. Filler migration can happen for a variety of reasons- product selection, injection technique, poor product placement, poor patient compliance, years of repeated filler placement and the list goes on. Even sometimes despite our best efforts and the perfect scenario, it still migrates due to the functional nature of the orbicularis oris muscle. We have all had the patient sit in our chair requesting a lip refresh and as injectors, all we can see is the displaced filler. Most of the time, the patient is completely unaware until we point it out. As difficult as it is for the patient to hear, the right action to take is dissolving and starting over. I would say 80% of patients request time to allow it to naturally dissipate, however migrated filler typically will not dissolve on its own, or at least within any reasonable amount of time. Attempting to place additional filler in a case of migration will only exacerbate the situation and lead to unappealing results. Anywhere from 1-3 sessions of hyaluronidase will help to dissolve the old filler and allow for a fresh start. I typically recommend waiting 4 weeks after the final dissolving session before replacing filler to allow all of those channels to close. The risk of replacing filler sooner is that the gel will again migrate through the open channels leading to the white lip and you end up right back where you started.

Some considerations to keep in mind once you are ready to refill the lips would be product selection, technique, quantity and timeframe. When we dissolve and start fresh, this may be a great opportunity to switch up products, especially if the patient has had the same product repeatedly injected over the years. As for technique, placing product in vertical struts does increase the risk for migration due to disruption of that vermilion border. For those patients who have had migration of product with a previous right-angle technique, there should be a strong consideration against that same technique upon refilling the lips. Quantity and timeline may be two of the most important considerations. Too much filler placed in one visit or subsequent visits timed too closely together can increase the risk of migration. When the lips are filled too quickly, the product essentially has nowhere to go and therefore it can either migrate up to the white lip or outwards giving a “ducky” appearance. The best advice would always be to go slow! Rome was certainly not built in a day and neither are beautifully filled lips, especially following a case of migration.

Below are a series of photos walking you through a filler migration case. The patient had been receiving lip filler about every 6 months for several years. Upon examination (in the initial photo) it was evident that the filler had migrated into the white lip. She did require 3 sessions of hyaluronidase to completely dissolve her existing filler. Upon refilling her lips, she received 0.6mL of a medium hyaluronic acid dermal filler. Both product and technique were changed to ensure that she did not have a recurrence of migration. In the end, both patient and provider were thrilled for the opportunity to start fresh!

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