Filler Migration
Dermal filler migration refers to the movement of the filler material from the intended site of injection to another area under the skin surface. Dermal filler migration can occur at any time after treatment, but it’s most likely to happen within the first few weeks to months after the injection.
Causes of dermal filler migration
There are several factors that can contribute to filler migration. Let me explore with you some of the more common causes of filler migration:
Injection technique
The injector’s technique is a significant factor in the risk of filler migration. Injecting too superficially, injecting too much filler, or injecting in the wrong location can all increase the risk of filler migration.
Product choice
Not all dermal fillers are the same. Some fillers are more prone to migration than others. Thinner, more fluid fillers such as those made from minimally cross-linked hyaluronic acid are more likely to migrate than thicker, more viscous homogenised fillers which can form lumps.
Movement
Areas of the face that are prone to movement, such as the lips, cheeks, and tear troughs, are more likely to experience filler migration due to the constant motion of the muscles and skin in these areas. Areas not subject to repeated movement, like the nose and cheeks are subject to gravity migration.
Volume loss
In some cases, filler migration can occur due to underlying volume loss in the treated area. When the skin loses volume, it can cause filler to move or shift to an unintended location.
Anatomy
The underlying anatomy of the treated area can also contribute to dermal filler migration. Areas with more prominent blood vessels, muscles, or bone structures are more prone to migration as the filler may be attracted to these structures.
Aftercare
Proper aftercare is crucial to preventing dermal filler migration. Patients should avoid rubbing, massaging, or applying pressure to the treated area for at least 24 hours after the procedure. Additionally, patients should avoid strenuous exercise or activities that may increase blood flow to the treated area for at least 48 hours after the procedure.
Signs of dermal filler migration
The presentation of filler migration will depend on the severity and location of the migration. Here are some of the signs that filler has migrated:
Lumpiness
If the filler has migrated to an unintended location, it may create lumps or bumps in the treated area, giving the skin an irregular texture.
Asymmetry
The most common sign of filler migration is asymmetry, where the treated area looks uneven or lopsided compared to the opposite side.
Discoloration
In some cases, filler migration can cause the skin to appear discoloured, such as a bluish tint in the area around the eyes.
Pain or discomfort
If the filler has migrated to a sensitive area, it may cause pain or discomfort in the treated area.
Restricted movement
In some cases, filler migration can restrict movement in the treated area, making it difficult to move the muscles in the face.
The Tyndall effect
Tyndall effect is a phenomenon in which light is scattered by particles in a transparent medium, such as dermal filler. When dermal filler is injected too superficially or in a thin-skinned area such as the under-eye area, the filler may be visible under the skin as a bluish tint.
The bluish tint occurs because the filler particles scatter light in a way that is like the way that light is scattered by the particles in the atmosphere, which causes the sky to appear blue. When light hits the filler particles, it scatters and reflects off the particles, making them visible through the skin.
Areas prone to dermal filler migration
The migration of filler can occur in any area of the face where the filler has been injected. However, some areas are more prone to migration than others. Here are some of the areas where filler migration is commonly observed:
Lips
The lips are a very mobile area and are prone to movement, which can cause filler to shift from the intended location.
Tear Troughs
Filler migration in the tear trough area can occur due to the thinness of the skin in this area and the presence of muscle movements around the eyes.
Cheeks
The cheeks are another area where filler migration can occur due to the natural movement of the face when speaking, eating, or smiling.
Nasolabial Folds
The nasolabial folds are the lines that run from the nose to the corners of the mouth, and they can be a difficult area to treat with fillers. Improper placement or overfilling can result in migration to the surrounding area.
How I treat dermal filler migration
The management of migrated filler will depend on the severity of the migration, the location of the filler, and the patient’s individual circumstances. Here are some possible options for managing migrated filler:
Observation
In some cases, minor filler migration may resolve on its own without any intervention. I may advise the patient to wait and observe the area for a few weeks to see if the filler settles back into place.
Massage
If the migration is minor, the “5-5-5” targeted massage protocol may be used to manipulate the filler back into its intended location.
Hyaluronidase
If the filler is made of hyaluronic acid, the injector may use hyaluronidase, an enzyme that breaks down hyaluronic acid, to dissolve the filler and correct the migration.
Needle Extrusion
If the dermal filler is visible under the skin, the doctor may perform needle extrusion, a process where a large needle punctures the skin and the material squeezed out.
Surgical excision
In rare cases, surgical excision may be necessary to remove the migrated filler. This is typically reserved for severe cases where other management options have been ineffective.
It’s important to note that managing migrated filler can be complex and requires a skilled injector with experience in correcting filler complications. Patients should choose a medically qualified with a track record of successful filler treatments and complications management. Additionally, patients should follow all post-treatment instructions carefully to minimize the risk of filler migration.
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