Could this be nasolabial filler migration? (Photos)

Question

I had 0.25 filler in each smile line in late 2022 and then again one year later. I have noticed these fat pads more and more over the years. They are soft and disapear when I smile. Is this migrated filler or perioral mounds. I cant feel any filler inside them. Any advice would be great

Ebru Soylemez, MD · Answer

From the images and your description, what you are noticing may not necessarily be filler migration. In many patients, soft fullness in this area can also be related to perioral fat pads or normal age-related changes in facial fat distribution. The fact that the fullness becomes less visible when you smile and that you cannot feel a firm product inside the area may suggest that it is not simply migrated filler.
Another possibility is that small amounts of hyaluronic acid filler placed in the nasolabial folds can sometimes accentuate the natural contour of nearby fat pads over time, making them more noticeable.
The best way to determine the exact cause is with an in-person evaluation, and in some cases ultrasound can help identify whether residual filler is present. If there is migrated filler, hyaluronidase can usually dissolve it safely. If the fullness is related to perioral fat pads or volume changes, different treatment approaches may be recommended.

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful question. Concerns like this are actually quite common after filler treatments, and it’s understandable to wonder whether changes you’re noticing are related to the injections or simply normal facial anatomy evolving over time.

Based on your description, there are a few important clues. You mentioned that the areas are soft, become less noticeable when you smile, and you cannot feel firm filler within them. Those details actually make filler migration less likely.

When hyaluronic acid filler migrates, it typically presents differently. Migrated filler often feels slightly firm or rubbery, can create a persistent fullness that doesn’t disappear with facial movement, and sometimes produces a visible ridge or puffiness above or beside the original injection site. It also usually appears within months of treatment rather than gradually over several years.

What you’re describing sounds more consistent with perioral mounds or malar-related fat pad prominence, which are normal anatomical structures around the mouth. These small fat pads sit just lateral to the nasolabial folds and can become more noticeable with time due to natural aging changes, including:

• Gradual volume loss in the midface and cheeks
• Skin laxity and collagen loss
• Subtle shifting of facial fat pads

Because these structures are soft and dynamic, they often flatten when you smile, which matches your description.

Another factor to consider is that the amount of filler you received was quite conservative (0.25 mL per side). That is a very small volume and is unlikely to create large migrated deposits, especially years later.

In some people, when filler softens the nasolabial fold itself, it can make the adjacent fat pad slightly more noticeable by comparison. This isn’t migration, but rather a change in how the surrounding contours are perceived.

If the area continues to bother you aesthetically, potential approaches that dermatologists sometimes consider include:

• Subtle cheek or midface support to rebalance facial volume
• Skin-tightening treatments to improve laxity
• In rare cases, hyaluronidase if residual filler is suspected

However, from your description alone, this sounds much more like normal perioral anatomy becoming more visible with time, rather than migrated filler.

These changes are very common and part of the natural evolution of facial structure, even in people who have had only minimal filler treatments.

Could this be nasolabial filler migration? (Photos)

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