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

Question

I am in a conundrum where my cheek near my sinuses is super heavy. I've been to a specialist and they've deemed it not sinus ralated. So now I'm thinking it's either filler migration or a heavy mylar fat pad? It looks awful and feels physically heavy on my face. If I dont constantly smile/smize- ive been told i look very old. Ive had filler in my smile lines both hyaluronic ('18, '20,' 22) and Radiesse ('19). Cheeks were hyaluronic ('20, '22).

Nelson Lee Novick, MD · Answer

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.

Eric M. Joseph, MD · Answer

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

Leonard Grossman, MD · Answer

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.

Darryl J. Blinski, MD · Answer

On the nicely posted photos there seems to be possible combination of aging face descent with fat and HA filler deformity best to do in virtual consultation or in person consultation, but initial option might be entering mini facelift with SMAS plication , fee $5000. Also could do fat rafting nano type to cheeks and, injections of Cabella to nasal labial area to reduce the swelling. Additional fees will be incurred. Best to virtual consult is previous stated regards

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

Answers (4)

Answer: HA filler migration, bilateral fat cheek, deformity by migration, inferiorly combination of both treatment options?

Answer: HA filler migration, bilateral fat cheek, deformity by migration, inferiorly combination of both treatment options?

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Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.

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

Answers (4)

Answer: HA filler migration, bilateral fat cheek, deformity by migration, inferiorly combination of both treatment options?

Answer: HA filler migration, bilateral fat cheek, deformity by migration, inferiorly combination of both treatment options?

Browse related questions

Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.