Should I dissolve my Lip Filler migration & start over? (photos)

Question

Hi there! I filled my lips 15 months ago for the 3rd time in 5 years. It looks to me now that I have migration above my top lip. Since it’s been over a year, is it possible for filler to remain there for years? Do you think I should dissolve & start fresh? Thank you

Kenneth D. Steinsapir, MD · Answer

If you can cope with it, yes remove all this filler and start over again. It is critical that you find a filler who understands the value of high G prime fillers for the lip. You get migration like this when runny, low G prime fillers are uses. Examples of this include Restylane Kysse, Belotero, and all of the Juvederms. These are low G prime fillers and immediately drift after placement. While you likely have more than a milliliter of filler in your lip, I think it is likely that you really do not need all that volume. I recommend Restylane for this application but it requires a skilled injector.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Jaime Haidenberg, MD · Answer

Hello,Yes, it is possible for filler to migrate and remain after a few years. I would recommend getting them dissolved and starting from scratch. Make sure to always see a reputable nurse or doctor to receive injectables. Good luck in your beauty journey!

Jeffrey Lisiecki, MD · Answer

Yes, it is possible for filler to last longer than the time it is "supposed" to. It does stimulate some production of collagen of your own, and it draws water to the area (depending on the type). Based on the photographs and your description, I would recommend dissolving and starting over fresh.

Nelson Castillo, MD · Answer

Thank you for sharing your question. Yes I would advocate attempting to dissolve the product above your lip to achieve an improved aesthetic outcome.

Nelson Lee Novick, MD · Answer

Since beauty is in the eyes of the beholder, since you apparently are unhappy with the final result, then dissolving the unwanted filler with hyaluronidase becomes a very reasonable approach. If fibrosis is present (resulting from the mechanical trauma of repeated injections to the area), then the enzyme may have to combined with the intralesional injection of an anti-inflammatory agent, usually triamcinolone. Going forward, you would be wise to consult with an experienced, board certified cosmetic dermatologist to ensure that  the appropriate filler is chosen, injected properly, and that the ideal proportionality of bottom to top lip is respected and that appropriate vermilion border definition is preserved. Hope this helps Best of luck.

Zoran Potparic, MD · Answer

In some cases filler may migrate from the area it is initially placed and create deformity. It is also possible that most of the bulk is coming from fibrosis (scar) around the filler. Injection of enzyme and  topical corticosteroid (Kenalog) may be used to improve this condition. Good luck.

Vibha Gambhir, MD · Answer

Hello and thank you for your question! After reviewing your pictures, It does seem as if there is migration of filler above the lip. Hyaluronic acid based filler is metabolized by our body over time, but that could potentially take some time. Hylenex or hyalurondaise is a medicine that can help to dissolve and break down the filler as long as a hyaluronic acid based filler was used. This may take a few appointments spaced apart.. I suggest returning to the provider that did the filler for you so they can further evaluate the area in person to come up with next steps for you! I hope this helps

Darryl J. Blinski, MD · Answer

Appears you had over filling of HA or some filler to the upper lip red mucosa and upper lip roll. Are you sure you had an HA filler? is the #1 issue. If it was HA filler a few sessions of HA dissolver in micro dosing might solve your issues. Expect fees per session at $1,000.