Can you advise on filler that migrated a year after getting it done?

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

It sounds like the migration or improper placement of the Juvederm in the first place may be causing what has been called the "pale, puffy lower eyelid pillow"--which may be a result of Juvederm's ability to draw a lot of tissue fluid to itself and/or from compression of the lymphatics causing edema. This can be a very long-lasting and difficult to problem to treat. The treatment of choice, like it or not, is hyaluronidase. Then, if necessary, the area may have to be retreated. Sorry.

Filler migration is possible but not highly likely assuming proper injection. It also occurs within the first few days if it does occur so it's easy to detect. ​In general, if it continues to feel uncomfortable up to this time, consult your doctor to get a complete assessment or have the filler dissolved if filler is still left. Hyaluronidase is a naturally occurring enzyme that breaks down hyaluronic acid, getting rid of the filler and reverting your appearance to its baseline state. If you are not satisfied you can always have it dissolved. Moreover, the administration of hyaluronidase is a highly technical procedure. There are so many factors to consider to determine if you are a good candidate for it, the best product to use, the right amount, injection technique, etc. Please contact a qualified provider or a board-certified physician with extensive experience in these procedures.