Filler Migration. When Is It Time To Start Fresh?

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.