I believe this is filler migration and it is getting worse. Help!!! (photos)

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hi @itziebitz! There are a few reasons for this swelling. One being that the filler was not placed in the proper tissue plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Another reason for the prolonged swelling can be due to the fact that too much facial filler product was used. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections.

Robust fillers, such as Voluma, tend to attract tissue water resulting in edema swelling, which can be particularly prominent and visible in the thin, delicate under eye area. Fillers, such as Restylane under the eyes, especially when placed too superficially have been known to cause bumpy swellings, as well. For this reason, less robust, cohesive fillers, such as Belotero Balance and Teosyal Redensity II, are preferable for use for treating under eye hollows and tear troughs. Moreover, the more robust the filler, the more likely it is to give rise to impedance of the proper lymph drainage in the region, which can show up as puffy pillows in the upper cheek/lower lid border regions, as may be the issue here. If this is indeed the case, I have had personal success treating patients who have come to me with such problems using varying concentrations and amounts of intralesional triamcinolone, 5-FU +/-hyaluronidase. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps.

I'm sorry you are unhappy with your filler treatment. Both Juvederm and Restylane are HA fillers which means they can be dissolved with hyaluronidase. Visit with an expert injector to discuss your concerns, and if desired you can have your filler dissolved.