These are questions I get asked regularly, and 60% of the time the answer is yes your dermal filler has migrated, and no your lip filler outcome is not normal.
Unfortunately in the industry today, some dermal fillers used, whether this be due to cost for the injector, hence larger profit margins and or publicity of the brand, are known to cause some issues over months or years post-treatment. The ability for the dermal filler to migrate is determined by the attributes the product has, the abilities the injector possesses and the amount of dermal filler used. Dermal fillers vary between brands and products within each brand.
The most common fillers today are products that contain substances similar to Hyaluronic acid. Hyaluronic acid (HA) is a natural substance found in the body.
HA dermal fillers consist of long chains of hyaluronic acid. Most dermal filler products will consist of HA cross-linked with a chemical such as 1,4-butanedioldiglycidyl ether (BDDE) for Restylane, Belotero and Juvéderm, divinyl sulfone (DVX) for Hylaform, 1,2,7,8-diepoxyoctane (DEO) for Puragen, and suspended in a physiological or phosphate-buffered solution.18 The product is then processed as a homogeneous gel or a suspension of particles in gel carriers.
The way in which HA fillers are manufactured/ produced has given rise to differences in properties in fillers. For example variability between the degree of cross-linkage, particle size and concentration within each product. These properties are vital in determining the clinical performance of the filler.
So when you look at the properties each product has, it can become apparent which products are more likely to cause migration later on.
What is “migration”?
Migration can mean several things in the aesthetic industry. Simply put lip filler migration means that your lip fillers have moved or spread unintentionally. If your lip fillers have migrated, it will almost always be noticeable visually. This can be presented in many ways; from a puffy upper lip, a lack of a defined border between the lip edge and above and/or below the lip border. Essentially it can create lumps or bumps that create notably misshapen lips and can prevent them from closing properly. We’ve all seen it and we’ve all heard about it.
How does migration happen?
Migration happens for any one of a number of reasons. All of these reasons should be considered when you make the choice to get lip fillers and who to get them done with. Below we give you some basic advice on how migration can happen and how you can avoid it.
1. Research your practitioner
We cannot stress enough just how important it is to know who you are allowing to carry out your procedure. With the explosion in popularity of lip fillers there has never been more choice in clinics offering aesthetic treatments. However, this isn’t always a good thing. It has led to a huge rise in the amount of poorly trained, unprofessional practitioners out to make some quick cash with little regard for the quality of service. Lip filler migration can occur as a result of the fillers being poorly administered by the practitioner. In the UK you do not need to be medically trained to administer lip fillers. By choosing to use someone who is will drastically reduce your chances of your fillers migrating elsewhere. This is why it is so important to do your research and only go with fully insured, fully licensed practitioners with a proven history in fillers and aesthetics. Whilst a renowned and reputable clinic might not be the cheapest – can you honestly afford to take a risk with someone else?
2. Make sure they are using trusted brands
Similarly to the point made above, with the increased popularity of aesthetic treatments; lip fillers, in particular, there are more and more unproven brands trying to break through into the market. Do not be afraid to ask your practitioner what fillers they use as results and effects can vary dramatically from one to the next. You need to be confident that they are going to be using the right fillers for you. Most importantly you need to ensure that the products being used are reversible. Some practitioners are still using products that cannot be dissolved or are incredibly hard to reverse. Not only can this mean that you might end up stuck with lips that you do not like the look of (especially if the fillers migrate), but it almost means should anything go wrong they can potentially be incredibly dangerous. At L1P we only use dissolvable fillers for this reason. (Dr Ranjbar typically tends to use hyaluronic based products that are bespoke to the patients history and desired outcome. Products that may be used are Teoxane, Juvederm, Restylane etc)
3. Make sure you receive the correct amount of filler
Lip filler migration commonly occurs as a result of too much filler being injected into an area and “bleeding” elsewhere. The best thing about injectable fillers is that your practitioner will have full control over exactly how much filler is being applied into each area of your lips in order to achieve the desired look. As bleeding of the filler can occur when too much is applied to a particular area it is vitally important that you inform your practitioner if you have previously had fillers applied and when. This will ensure that they can use the correct amount to prevent migration from ever happening. Overfilling lips can cause pain and discomfort as a result of bruising. It can also cause your lips to become discoloured. As such, a good practitioner will always ensure that you as a client are aware of exactly how much is too much.
4. Aftercare is essential
Filler migration will not always be as a result of a poor practitioner. Filler migration can also occur when the client does not follow the correct aftercare procedures. When you have received your lip fillers, your practitioner should always give you aftercare advice that it is so essential that you follow. You need to ensure that you are playing your part by allowing your lips to fully heal by taking the proper precautions.
Will migrated filler go away on its own?
In theory, yes, but the reality is a bit more complicated. When we dissolve fillers we inject an enzyme called hyaluronidase. Hyaluronidase is naturally occurring in your body and this is the reason that lip fillers will eventually dissolve on their own. If migration occurs and the dermal filler being is in the wrong compartment if your lips this may take several months to years to degrade enough to enable visualisation of a clear lip border again. This is why in some instances we would suggest actively dissolving your existing lip fillers before injecting more.
Whilst you do not need to be medically trained in the UK to administer dermal fillers, only medical professionals can prescribe hyaluronidase. This is another reason why using a trained medical professional to carry out your lip filler procedures is advised. You can be assured that should anything go wrong they will be able to administer the appropriate treatment in a timely fashion. They will also not be under pressure to carrying out potentially dangerous procedures where full or partial dissolving would be safer and achieve a far better result for you in the end without the risk of further filler migration.
Can I get more lip filler if I have migration?
Again, in theory, yes, however, you may not get the desired look you are after. At L1P we advise a consultation so that Dr Ranjbar can determine the full extent of the migration. As mentioned before, there will be some instances where it would be advisable to either dissolve fully or try to pinpoint where to dissolve. Actively dissolving fillers usually takes between 3 and 4 days after treatment. You should also be aware that when dissolving fillers, the results you want may not always be achievable within one sitting of treatment. Sometimes two or three rounds of treatment may be needed to achieve the results that you are after, so it is important to discuss this with your practitioner.
I’ve had my fillers dissolved. How long do I have to wait before I can get more?
This is a question that we get asked all the time. You might have read elsewhere that you will only need to wait two weeks after having your fillers dissolved before having new ones. We don’t want to be the bearers of bad news but we believe that honesty with you as our clients is important and we are afraid this isn’t the case.
While for some people two weeks might be acceptable after having a small amount of filler dissolved, for most people this simply isn’t long enough. The truth is – the longer you leave your lips, the more time they will have the heal and the better your results will be in the future. Some of L1P’s previous clients have chosen to wait for three, four and even six months after having migrated filler dissolved before having them again. Most people may be expected to wait anywhere between 4 and 6 weeks for desirable results. As always though, your individual circumstances can always be discussed and assessed in a consultation.
View our article on a client’s journey in needing to dissolving her lips and the problems she has faced with her lip Fillers.
Yeom J, Bhang SH, Kim B-S, Seo MS, Hwang EJ, Cho IH, et al. Effect of cross-linking reagents for hyaluronic acid hydrogel dermal fillers on tissue augmentation and regeneration. Bioconjug Chem. (2010) Feb;21(2):240–7.
Written by Dr. Ranjbar
Medical Doctor & award-winning aesthetic practitioner in West Sussex