Help! Is this filler migration? Or heavy malar fat pad? (Photos)

I am sorry that you are having this issue. There is a possibility that this problem is one of filler-related lymphatic obstruction (lymphedema). If so, it can be a persistent and particularly difficult one to treat. HA fillers have the distinct advantage of being able to be dissolved with the enzyme hyaluronidase, which may be helpful as a component of the treatment for this condition. Radiesse, on the other hand, is a semipermanent filler and has no comparable dissolving enzyme, which is the reason I stopped using this product quite a few years ago when the longer-lasting HA were FDA-approved and came to market. The problem is believed to arise from too superficial injection of filler and/or the inappropriate choice of filler for the upper mid-cheek region under the eyes. That being said, I have treated quite a few cases of people who have come to me with the filler-related lymphatic obstruction (lymphedema) and have had gratifying results using and algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist and best of luck.

Hyaluronic acid is a hydrophilic filler. That means it tends to attract water. Since your upper cheeks appear to be somewhat swollen and puffy, this could be from a bit too much hyaluronic acid that was injected on two occasions in 2020 and 2022. In that regard, you may wish to visit a facial plastic surgeon or cosmetic dermatologist who would be able to assess your situation and consider whether or not the dissolving enzyme would be feasible. I hope this helps! Sincerely, Dr Joseph

It appears that someone has clearly injected your lower eyelid with a hyaluronic acid filler. I have been saying this for over 25 years that no hyaluronic acid filler should go into the lower eyelid as it gets pushed around by the muscle that’s surrounds the eye. This process creates a lower eyelid bag as well as Tyndall effect. Your best option is to gently and patiently dissolve the filler using Hyaluronidase (that means Small amounts, which may require two or three treatments, rather than all at once). Once the hyaluronidase has had a nice effect, and the bag is gone, I would do fat grafting, which, in the right hands should provide with a natural, beautiful and nearly permanent result. I hope this helps and good luck from New York City Plastic Surgery.