What to do about filler migration? (Photo)

This is lip shelf. It is the result of being injected with a runny filler. The public has been told that fillers persist for about a year. But this is entirely not accurate. While the wonderful clinical effect may persist for 9 to 12 months, the volume itself does not simply disappear. Rather it adds generally not helpful volume to the face. At first this extra volume is not noticeable. However, over time as more material is injected to top off the desired clinical effect, the extra volume is a problem. In addition, it seems that as filler ages in the face, it tend to hold more volume. This may reflect the changing nature of the retained filler as the body slowing breaks it down. This material can persist. In my clinical experience, I have removed fillers that had been adding unwanted facial volume for over a decade and more. I strongly recommend getting all of the lip material removed. This is likely going to require 150 units of hyaluronidase. You may actually benefit from two rounds of enzyming. Forget about the scary internet posts that enzyme wrecks your skin. I have treated thousands of patients with enzyme and I see no evidence of this. What I do occasionally see are patients where a well meaning injector injected a very small dose of enzyme (a squirt) and simple mobilized filler into the dermis causing a boggy edema. This is immediately resolved with a proper enzyme treatment. I wish it were possible to preserve some of your lip volume but this will not be possible if you what the lip shelf resolved. Once the material is removed, you can have an appropriate refilling treatment. I recommend only Restylane for this purpose.

Thank you for your pictures and questions. In this case, I think the answer is pretty easy. This filler needs to be dissolved and then start back from scratch. May take more than one session to dissolve. Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

In my personal opinion fillers do not migrate. The concept is used as a convenient excuse to explain poorly done procedures.
At seven months your product should be more or less gone. Consistent use of HA fillers can create permanent changes.
We don’t really understand the mechanism but it probably has to do with chronic inflammation creating some scar tissue.
At seven months, I see no point in trying to reverse the filler, since it is most likely all gone by now.
Some people do develop permanent changes from the use of fillers.
It’s also important to remember that the aging process continues and overtime. Everybody experiences certain changes in their face.
I don’t think there is any simple treatment for your concern. You can try reversal, but I don’t think it’s going to do much.
Best,
Mats Hagstrom, MD