Filler went wrong & still in smoke lines after 3 years, advice? (Photos)

Thank you for sharing your experience. I’m truly sorry you’re going through this. It can be incredibly frustrating to deal with lingering filler and textural changes, especially after multiple treatments and attempts at correction.

Based on your description, it sounds like you're dealing with residual filler trapped in perioral (smoker’s) lines that has not fully responded to hyaluronidase or resurfacing procedures like microneedling, RF, or HALO. This does happen, particularly if the filler used was denser or placed too superficially.

Here are a few options to consider moving forward:

Ultrasound-Guided Assessment and Dissolution:
Some fillers become encapsulated or migrate in a way that makes them difficult to fully dissolve without precise visualization. An ultrasound-guided approach allows a skilled provider to see exactly where residual filler is and inject hyaluronidase with high accuracy. This can be especially helpful when previous dissolving attempts were incomplete.

Subcision with or without Cannula-Based Filler Removal:
If the issue is not just filler but also fibrotic bands or scarring, subcision (a technique where a needle is used to release tethered skin) may help smooth out the texture. This can be combined with enzyme injections or fat grafting, depending on your skin's response.

CO2 Laser Resurfacing or Advanced Fractional Ablative Lasers:
If you haven’t already, a more aggressive fractional CO2 laser—performed by an experienced dermatologist or plastic surgeon—can remodel deeper skin texture, especially when scar-like tracks or persistent smoke lines are present.

Small Bump ("Circle Bump"):
This could be a filler nodule, granuloma, or scar tissue. Again, ultrasound can help differentiate this and guide targeted treatment—either with hyaluronidase, steroid injections, or minor excision if needed.

Camouflage & Skin-Boosting Fillers (Later on):
Once everything is resolved and your skin texture is more even, there are very delicate fillers like SkinVive or diluted Sculptra that can be used to hydrate and improve the skin’s appearance, but only after full correction of the current issue.

Please don’t give up. You absolutely deserve to feel comfortable in your skin, and while this might require a specialized, layered approach, there are options. I would be happy to assess you further through a detailed virtual consult or recommend trusted colleagues if you’re located outside my practice area.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. One option might be to use hyaluronidase to dissolve any remaining hyaluronic acid filler if that’s the type you received. This can help eliminate the unwanted filler and may improve the overall appearance of the area. Since hyaluronidase can affect both the filler and any natural HA, it’s important to discuss potential outcomes with your injector. If you’re concerned about the texture or appearance of your skin post-dissolution, treatments like microneedling or laser resurfacing can help improve skin texture and stimulate collagen production. These options can soften the appearance of lines and enhance overall skin quality. Another consideration is to explore new filler options or techniques after the previous filler has been addressed, which can help create a smoother, more even appearance. I hope this helps and best of luck!

Depending on your examination, dilute steroid injections might be helpful for dissolving some scar tissue that may have formed around your filler. The up the other option to consider might be light Electro surgery to flatten the raised areas. This could be done in the office with topical anesthesia and minimal inconvenience. I hope this is helpful. Sincerely, Dr Joseph

If there is any filler present you can have it dissolved with hyaluronidase. Kenalog injections may help if indicated. To improve overall texture you can explore laser resurfacing. This can improve skin tone and texture for the whole face, giving a rejuvenated look.