40 years old, previous lip filler 3 years ago. Left side of mouth is weird - lip filler migration? (Photo)

Question

Im 40 years old. I’ve had quite a bit of lip filler over the years, but none for the past 3 years. I had HIFU on my lower face & jawline 6 months ago .I know my lips are overfilled, as I have a shelf. But that deep smile line & sharp upturned lip corner only appeared in the past month. It looks so weird. The right side of my mouth looks normal. What can I do about it?? The HIFU successfully reduced jawline fat & tightened my jawline. Could it be related to that deep crease and weird smile line? I just want the left side of my mouth / smile to be the same as the right side.

Anna Chacon, MD, FAAD · Answer

I can understand why this would be concerning, especially when the change seems to have appeared fairly suddenly and only on one side. Facial asymmetry that develops over a short period often feels much more noticeable to the person experiencing it than it may appear to others, but it's still worth understanding what could be contributing to it.

Based on your description, there are a few possibilities that come to mind.

Could This Be Filler Migration?

It's possible, but the timing makes me somewhat cautious about blaming filler migration alone.

The "shelf" above the lip that you mention is a classic sign that some filler may have migrated beyond the natural lip border. Interestingly, we now know that hyaluronic acid filler can sometimes remain in the tissues far longer than initially believed—even several years after treatment.

That said, filler migration typically develops gradually rather than causing a sudden deep crease or a new asymmetry that appears within a month. If residual filler is present, it could potentially be contributing to uneven tissue support around the mouth, but it may not fully explain a newly developed unilateral change.

Could HIFU Be Related?

Possibly.

HIFU works by delivering focused ultrasound energy into deeper tissue layers to stimulate tightening and remodeling. While most patients experience improvement in skin laxity and contour, the treatment can occasionally alter facial volume distribution or highlight pre-existing asymmetries.

If some fat reduction occurred unevenly, particularly around the lower face or perioral region, a crease or fold that was previously subtle may become more apparent. Six months is within the timeframe when collagen remodeling effects are still evolving, so I would not completely rule out a connection.

In some individuals, volume loss can actually make certain smile lines appear deeper because there is less soft tissue support underneath the skin.

Other Possibilities Worth Considering

A few additional factors may contribute:

Natural age-related volume loss that is simply becoming more noticeable on one side
Differences in facial muscle activity between the right and left sides
Changes in dental alignment or bite mechanics
Sleeping habits and repetitive facial positioning
Mild nerve or muscle changes that affect the way one corner of the mouth moves

Often, facial asymmetry is multifactorial rather than having a single cause.

Why the Upturned Corner?

The sharp, upturned appearance of one lip corner is particularly interesting because it suggests that either:

The tissues around that area are being pulled differently by the underlying muscles, or
The surrounding volume has changed, making the corner appear more elevated relative to the rest of the lip

This is another reason why muscle dynamics and volume changes are important considerations in addition to filler migration.

What Usually Helps?

The solution depends entirely on the underlying cause.

If residual filler is contributing to the asymmetry, dissolving some of the older hyaluronic acid filler may improve balance and restore more natural contours.

If volume loss or tissue support is the issue, strategic restoration of volume may be more appropriate than adding filler directly into the lips.

If muscle imbalance is playing a role, treatments targeting muscle activity may sometimes help improve symmetry.

The most important thing is determining whether the change is being driven primarily by filler, volume loss, tissue remodeling from HIFU, muscle dynamics, or a combination of factors.

My Overall Impression

Given that you have not had filler for three years, yet developed a new crease and asymmetric smile line only within the past month, I would be hesitant to attribute everything solely to filler migration. Residual filler may still be present and contributing to the overall appearance, but the timing raises the possibility that tissue remodeling, volume changes, or muscle-related factors are also involved.

The encouraging part is that asymmetries around the mouth are often understandable once the underlying anatomy is carefully evaluated, and many can be improved once the primary cause is identified.

Yasemin Aydinli, MD · Answer

Thank you for sharing your story &mdash; this is a very understandable concern. What you are describing sounds multifactorial. Old lip filler can persist far longer than advertised, and when it migrates above the lip border it creates the "shelf" you mention. At the same time, HIFU treatments reduce fat and tighten tissue, and when the lower face deflates or tightens slightly unevenly, pre-existing asymmetries that were previously camouflaged can suddenly become visible. The timing you describe &mdash; a new crease and upturned corner appearing months after HIFU &mdash; fits this pattern.
My usual recommendation in this situation is to start by simplifying the picture: have the residual lip filler dissolved with hyaluronidase. This removes the migrated product, eliminates the shelf, and lets us see your true baseline anatomy. Dissolving is quick, low-risk, and often improves the perioral contours by itself. Once the tissues have settled for a few weeks, the remaining asymmetry can be assessed accurately and treated precisely &mdash; whether that means a small, conservative refill placed correctly within the lip, a drop of filler to support the corner of the mouth, or a tiny amount of neuromodulator if a depressor muscle is pulling that corner down.
I would advise against adding more filler on top of the current situation, as that tends to compound the problem. An in-person assessment (including watching your smile dynamically) would allow a precise diagnosis, but the dissolve-first approach is almost always the right opening move here.

40 years old, previous lip filler 3 years ago. Left side of mouth is weird - lip filler migration? (Photo)

Answers (2)

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