Small pockets above my upper lip - is it more likely to be fat or 8 year old migrated filler? How can they be removed? (Photo)

Question

I have little pockets above my upper lip, just off to the sides that make my nasolabial fold quite harsh and permanent when I am relax. I have tried treading in those areas to tighten but it hasnt help. Is it more like to be fat or migrated lip filler? I had lip filler (only 1ml) approx 8 years ago. What are my options? 33, female, 62kg

Anna Chacon, MD, FAAD · Answer

Based on your description, it is difficult to determine with certainty from a photo alone whether those small pockets are due to residual filler from 8 years ago or simply your natural facial anatomy and fat distribution. In my experience, after such a long period of time, most hyaluronic acid fillers have typically been broken down by the body. However, there are cases where small amounts of filler can persist longer than expected, particularly if it was placed deeply or if there has been some degree of filler migration.

That said, the area you are describing—just lateral to the upper lip and contributing to a deeper nasolabial fold—is also a common location for natural fat pads and age-related volume changes. Sometimes what appears to be a "pocket" is actually a contrast between fullness in one area and volume loss in an adjacent area.

If filler migration is suspected, an ultrasound examination can often help identify whether filler remains in the tissues. If residual hyaluronic acid filler is present, treatment with hyaluronidase may be an option.

If the fullness is related to natural fat or facial structure, treatment options may include:

Strategic filler placement in surrounding areas to improve contour balance
Energy-based skin tightening treatments
Microneedling radiofrequency treatments
In some cases, surgical contouring procedures for patients seeking a more definitive correction

The best approach depends on whether the concern is true excess volume, residual filler, skin laxity, or volume loss nearby. At age 33, many patients are surprised to learn that early facial volume shifts and tissue positioning can create shadows that make folds appear more pronounced even when there is no excess fat present.

A detailed in-person evaluation and, if needed, ultrasound imaging would be the most reliable way to determine the cause and select the most effective treatment.

Frank Agullo, MD · Answer

I have seen this with HA fillers injected 8 years ago that were still sitting there like a discrete lump. HA fillers are supposed to be temporary, but science shows they can last well over five years, depending on patient, depth, and small migration over time. Most often these little bumps lateral to the philtrum, to my eye, read as filler migration as opposed to fat.

The easiest way to definitively tell is to inject hyaluronidase into each bump. If the bumps resolve within one to two weeks, it was filler. If the bumps do not resolve, the bumps either consist of fat or the pockets were indeed scar tissue, and in that situation, you could do a minor in-office needle release of the pockets with minimal fat reduction if there is even some fat there.

#StayBeautiful,

@RealDrWorldWide

Small pockets above my upper lip - is it more likely to be fat or 8 year old migrated filler? How can they be removed? (Photo)

Answers (2)

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