The Practitioner’s Guide to Avoiding Filler Migration

Social media has millions of examples of filler gone wrong. On TikTok alone, #lipfillermigration has over 2 million instances of educational and informational videos, words of advice, and horror stories. These videos, and the personal experiences they share, demonstrate that filler migration is a problem that is often encountered in the world of medical aesthetics. In this article, we discuss filler migration, what it is, how to fix it, and how to avoid it in your practice.

What is Filler Migration?

Filler migration is exactly what it sounds like: when filler migrates beyond the treatment injection area. Filler migration can be noticeable around two weeks after treatment when an accumulation forms visible bumps adjacent to the treatment area. Filler migration is often experienced with lip fillers; the filler migrates beyond the vermillion border into the skin or cutaneous portion of the lip. This can either create lumps on the lips, or create a shelf or plateau that is characteristic of the “duck lip” phenomenon.

Filler migration is not limited to the lips, it can occur anywhere filler is injected: in the cheeks, tear trough area, and hands.

What Causes Filler Migration?

Filler migration is typically caused by improper technique. One of the most common signs of filler migration is fullness adjacent to the injection site. This is characteristic of the injection procedure occurring too superficially or too quickly, or the injection unintentionally performed in the wrong layer of tissue, or into a blood or lymphatic vessel. 

Using an inappropriate dermal filler can also affect filler migration. Different dermal fillers have different properties, and optimally function for different indications. For example, injecting a thick filler (such as a calcium hydroxylapatite filler) into the thin skin of the lip or tear trough area could have cosmetically disastrous effects.

Generally, it boils down to the experience and training of the practitioner. Inexperienced injectors may inject too much filler, inject the filler in the wrong area, they may demonstrate improper technique, or they may not space treatment sessions out appropriately. Each of these issues can lead to poor treatment outcomes, including filler migration.

How to Fix Filler Migration

Filler migration is typically resolved through dissolving the filler with hyaluronidase. This compound breaks down the hyaluronic acid in the filler, allowing the built-up filler to essentially dissolve, and be excreted with the body’s natural excretion process, causing minimal harm (if any) to the patient. 

Fillers are designed to break down naturally over time, therefore with minimal harm in most cases, the patient can also wait until the filler dissolves on its own. However, this is typically not best-practice, given that every patient reacts differently to filler, and the time it takes to break down filler can vary between patients. Furthermore, the cosmetic effects of filler migration can be distressing to patients.

How to Avoid Filler Migration

Above all else, it is important to stay up-to-date on medical aesthetic education, particularly injection techniques. Having a solid understanding of knowledge and technique is the best way to ensure optimal results for your patients. The Canadian Association of Medical Aesthetics provides a variety of courses, delivered in both 1:1 and classroom training formats, for practitioners looking to learn or upgrade their medical aesthetic skills, including cosmetic injection skills. Click here to find out more.