Does this look like filler migration or melasma? What should I do? (Photos)

Question

I received lip fillers for the first time in Dec 2021. I only received 1 cc. I went in to do another 1 cc in Mid-March. I’ve had a brown line on my upper lip. I’m not sure for how long it could’ve been before I got the procedure. Does this look like filler migration or melasma? What should I do? I would like another round of filler, but if it’s migrated I should dissolve first.

Raffy Karamanoukian, MD, FACS · Answer

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Eric M. Joseph, MD · Answer

When too much filler is injected into the upper lip, fullness and a description of a mustache are commonly described. In that regard, please consider not getting any further filler at this time. Digital photos are not a substitute for an examination, however, since the brown mark is much less visible on profile than on front view, I suspect it's darkness is due to shadowing rather than a change in the pigment of your skin. Hyperpigmentation of your upper lip after lip filler would be very unusual. Hope this helps. Sincerely, Dr Joseph

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!From your photographs, I note a degree of transverse hyperpigmentation immediately above the vermillion border of the upper lip. There is also a degree of "migration" of the filler beyond the vermillion border as the upper lip may be slightly overfilled. Postinflammatory hyperpigmentation appears to be the cause of the brownish discoloration . If persistent, treatment may be required. Topical hydroquinone (a bleaching agent) and retin-A have been shown to offer improvement. If refractory, a chemical peel may be required.As your last injection was performed only 4 months ago. It is best to wait for the previous injection to completely dissolve, allowing the inflammation (and hopefully the hyperpigmentation) to subside before contemplating further injections. Perhaps a different filler (or implant) should be utilized.Best wishes...

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