Filler Migration: Should You Be Worried? Experts Weigh In

According to the most recent American Society of Plastic Surgeons (ASPS) data (and some rough math), someone is undergoing a filler treatment nearly every five seconds. This past year, doctors recorded over six million treatments of dermal filler, making it the second most popular minimally invasive cosmetic treatment — after Botox, of course. But, lately, we’ve been hearing some pretty mixed reviews of the omnipresent treatment. Most commonly, we’ve heard rumblings that filler can “migrate” or move after it’s been injected. We’ve also heard horror stories that it might not dissolve or can even make your face puffy. Given it’s almost as widespread as Botox, we all agreed that we needed answers. Stat. So, we reached out to our network of experts to find out if filler migration is a myth or fact.

Why is Everyone Talking About Filler Migration Now?

If you feel like the term “filler migration” just popped up overnight, it’s not just you. It kind of did. Over the summer, a Beverly Hills oculoplastic surgeon posted a video to TikTok sharing the findings of an MRI scan of facial filler… and the internet went absolutely wild. The patient, a 33-year-old woman, reported she had 12 CCs of hyaluronic filler over the past six years, yet the scan showed that there was over double that amount of facial filler present under her skin, and in places she hadn’t even been injected. The video’s comment section became flooded with similar stories of having never-dissolving filler, which contradicts everything we’ve been told about filler.

Until now, we’ve been, we’ve always been under the impression that fillers are not permanent. If you ask any doctor, they’ll most likely give you a similar answer: HA-based fillers typically last anywhere from six months to a year and a half whereas non-HA-based fillers last a minimum of two years. It’s hard to predict exactly how long a filler will stay in someone’s body, but board-certified NYC cosmetic dermatologist Dr. Michele Green says the longevity of any filler can also be affected by the patient’s skin characteristics, metabolism, and lifestyle choices.

“Low skin elasticity makes it hard for the skin to hold a filler, leading to a shorter length of results. Fast metabolisms can lead to quicker degradation of a filler. Excess sun exposure can break down collagen fibers, leading to reduced longevity of a filler,” she tells us.

What is “Filler Migration” and Can it Really Happen?

Though it’s an uncommon side effect, our expert network confirmed that it’s not just a myth — filler migration does exist. For several reasons (we’ll get to that later on), it is possible for the injected filler to move from its injection site to another area of the face. But, to be clear, we’re talking about movement in millimeters, not anything drastic.

“Filler migration is not a common side effect of dermal filler injection procedures,” NYC-based board-certified dermatologist Brendan Camp, MD assures us. “It may be more likely to occur when someone gets filler treatments often in which a high volume of filler is used over time and is layered on previously injected filler.”

So, if you notice lingering asymmetry, lumps, unevenness, or puffiness after getting filler, then there’s a good chance it could be the infamous “filler migration.” According to Dr. Green, the dreaded filler migration can occur anywhere, but it most commonly presents itself in areas with thin skin, like the lips and tear troughs (under the eyes). While the onset of filler migration varies, Dr. Camp says it usually happens within days of the treatment if the injection was too superficial or within months as the filler is metabolized and its structure is altered.

But, again, remember that it’s not that common.

What causes Filler Migration?

While we can’t control whether or not our filler migrates, there are a few things to stack the odds in our favor. Dr. Green says that the most common causes of filler migration are overfilling, incorrect injection technique, and using the wrong filler.

Dr. Green breaks it down for us: “too much filler in an area can cause a pressure imbalance, resulting in the filler migrating towards adjacent tissues. Inadequate injection techniques, such as injecting too close to the surface or using excessive pressure, can also lead to filler migration. Additionally, there are many different types of fillers on the market, all with varying concentrations and formulations. Using a filler that is not suited for the injected area can result in filler displacement.”

While any filler can result in filler migration, Dr. Camp and Dr. Green both said that non-HA-based fillers are less likely to migrate compared to HA-based fillers. This is because they promote new collagen production, which reduces the risk of migration.

And, Dr. Camp warns that HA-based fillers can expand after treatment because the filler is not saturated with water in the syringe. As a result, the HA molecule attracts and retains water and can cause additional swelling after it has been placed in the skin.

Can You Remove Filler?

There’s a good chance you’ve heard conflicting answers to whether or not filler can be removed — and, that’s because some types of filler can be dissolved whereas other types can’t be. According to the experts, HA fillers can be dissolved whereas non-HA fillers can’t.

HA-based fillers can fortunately be dissolved with an agent called hyaluronidase, which is a naturally occurring enzyme that breaks down hyaluronic acid into its smaller components. Once injected into the area of filler migration, hyaluronidase acts immediately, with results visible after just 48 hours, says Dr. Green.

Unfortunately, there’s still no technology to dissolve or remove non-HA filler. The only solution is time and, depending on the type of filler used, patients may have to wait several months or years. That being said, Dr. Green said there are certain circumstances where a plastic surgeon might help, like if a granuloma has formed and can be excised.

The Bottom Line

Filler migration does exist, but it shouldn’t hold you back. While the issue isn’t black and white, there are always ways to mitigate risk, most importantly by selecting the right injector. Seeking treatment from a board-certified physician who has the knowledge to choose the right type of filler for you and inject it properly is the safest way to ensure you are getting ideal results.