Migrated filler - how can I improve this lumpy area at the top of my cheeks? (Photo)

Question

I had filler in tear trough and cheeks Restylane 8 years ago   Fast forward it has migrated onto the top of one of my cheeks.  In certain lighting I can actually see the lumpy areas.   I hate it.  My surgeon has tried twice to dissolve it and this just won’t go away!  Two rounds of fractional co2 laser to rejuvenate this 60 year old skin.  It did help a little but I truly hate looking in a mirror     I’m trying to find ways to get it to go down naturally as I am scared to dissolve again.  I’m using RLT every night, and massaging.  Some days it’s worse than others  All suggestions welcomed

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your experience. What you’re describing—delayed filler migration with persistent lumps after tear trough and cheek augmentation—is not uncommon, especially with older-generation fillers like Restylane used 8+ years ago.

You’ve taken many good steps already, and I understand your frustration after dissolving attempts and laser treatments. Here's a breakdown of what might help:

Why It Might Still Be There
Filler Encapsulation or Granuloma: Sometimes the body walls off filler, forming firm lumps that resist hyaluronidase (the dissolving enzyme).

Partial Dissolution: Two rounds of hyaluronidase may not have fully penetrated the encapsulated filler.

Residual Swelling or Fibrosis: Some “lumpiness” could be scar tissue or edema, not just filler.

Options for Treatment
1. Additional Hyaluronidase (With Caution)
If the filler is confirmed to still be hyaluronic acid-based, a more targeted, ultrasound-guided hyaluronidase injection may help.

A test patch could be done to reduce anxiety—small amounts at a time.

Lidocaine and steroid may be added to reduce inflammation from the injection itself.

2. Radiofrequency Microneedling (e.g., Morpheus8)
Helpful in remodeling fibrotic tissue, reducing lumpiness, and tightening skin.

This can also improve skin texture from both filler distortion and aging.

Less risk of pigment change than traditional fractional CO₂ in mature skin.

3. Manual Lymphatic Drainage Massage
Can assist if swelling or filler migration is worsened by fluid retention.

May soften appearance of asymmetry over time when done consistently.

4. Low-Level Laser Therapy (LLLT) or Red Light Therapy (RLT)
You’re already using this, which is great.

RLT can improve circulation and collagen remodeling, but effects are subtle and cumulative. Be patient and continue.

5. Injectable Steroids (if fibrotic nodule is present)
A very low dose intralesional Kenalog (triamcinolone) can help shrink firm lumps from scar tissue or granuloma, if suspected.

6. Camouflage and Skincare Support
In the interim, consider makeup primers with blurring effects, and gentle skincare with niacinamide and retinoids to even tone and texture.

Final Thoughts
What you’re experiencing may be a mix of filler residue, scar tissue, and natural aging skin changes. If further dissolving is too emotionally or physically uncomfortable, non-invasive skin remodeling (like RF microneedling) combined with conservative topical and massage therapy may yield gradual improvement.

It’s also okay to take a break—sometimes stepping back allows the tissue to stabilize and respond better to future treatments. You're clearly proactive and informed, which is an asset in navigating this journey.

Leonard Grossman, MD · Answer

As a general rule, fillers do not migrate. What do you have is a typical case of Malar edema. In order to treat it successfully, you need to dissolve all of the filler, and those fillers can stay around the area pretty much forever in some people. Once the filler is gone, which is approximately two weeks post treatment you should have fat grafting, which will get rid of the edema that you’re seeing. In the right hands, the results should be extremely natural and practically permanent. I hope this helps and good luck from Leonard Grossman MD organic Plastic Surgery.

Darryl J. Blinski, MD · Answer

Based on the one post a photo I recommend Endo treatment to sessions 3 to 6 weeks apart each session $1200. Best of virtual consult with.

Migrated filler - how can I improve this lumpy area at the top of my cheeks? (Photo)

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Migrated filler - how can I improve this lumpy area at the top of my cheeks? (Photo)

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