Do I still have lip filler migration? Filler was dissolved but I don’t think fully (photos)

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

Restylane Kysse is intended for lip treatment. Injectors have difficulting with high G prime fillers when treating the lip. The higher the G prime of a filler, the less likely it is to migrate after placement. However, many injectors have difficulty controlling these high G prime filler in the lip edge leading to unwanted lumps and bumps. Restylane Kysse is a low G prime filler intended to solve the problem with lumps and bumps. Low G prime fillers act more like liquids and less like solids. Bumps that are caused by treatment tend to resolve on their own as the product diffuses away from where it was injected. This type of filler can be characterized as "smooth" however, the fact is these products are runny. Treatment placed in the lip edge rapidly diffuses into the surrounding tissue causing the unwanted fullness outside of the lip edge. This is not unique to Restylane Kysse. It occurs with all low G prime fillers used to volumize the lip edge. Aesthetically you may like your lip treatment but yes, you look overfilled and the effect is less than natural. Decide what you are looking for. I very much like augmented lips that look natural. I recognize that some prefer a more dramatic effect. Find an injector who can deliver what you are looking for.

Thank you for sharing your question. You do continue to have retained filler that has migrated into the pale skin of your upper lip. Administration of more hyaluronidase should resolve the issue and I would advocate a thicker filler to minimize the migration risk in the future.

Hello Warmhearted454326:

How upsetting this must be for you! I believe you can avoid this problem by having smaller volumes injected. You should see an advanced injector with experience injecting lips over many years’ time. The placement must be precise.

All the best from NYC,
Sheryl Clark MD FAAD

An in person evaluation is best, but from your submitted photos it does appear you still have migrated filler present. It can take multiple treatments to get the product fully dissolved. I encourage you to return to your injector for an assessment.

Personally, I don’t believe it fillers migrate. I’ve been using fillers for well over 20 years and have never experienced fillers migrate. I believe the concept is an excuse used by providers to cover for poor technique.
Some individuals may have long-term sequela of having fillers with fullness that process, even after fillers are dissolved. The importance of choosing sufficiently experience and skills providers cannot be overstated.
Best,
Mats Hagstrom, MD