As aesthetic medicine continues to surge in popularity, patients are increasingly seeking non-surgical procedures, such as dermal fillers. This is to enhance their appearance without resorting to more invasive cosmetic interventions.
Fillers are one of the most sought-after procedures. They are an accessible and efficient way to treat facial volume lost through the process of ageing and create a rejuvenated, refreshed look.
Whilst effective, as with any medical procedure, fillers come with potential complications.
One is that of dermal filler migration – the process where the filler moves from its intended region to a different or undesired location. This usually results in patient dissatisfaction and alteration of the natural appearance of the facial features.
Here, we explore filler migration – from its causes and effects to prevention strategies and solutions…
What is filler migration?
To understand how to prevent dermal filler migration, we must first be clear on what exactly it is. Simply speaking, filler migration is the unintended movement of injectable dermal fillers from their initial placement to other areas of the face.
When an area is treated with filler, tension in the tissue can cause the filler to move to an area of less pressure. Various factors can influence this, which we will discuss below.
It can occur acutely (up to 2 weeks after injection) after injection or as a late presentation over time (up to and longer than 1 year). This leads to suboptimal aesthetic results such as a ‘wonky’ appearance, the dreaded ‘duck lips’, or lumps and bumps. All ending with patient dissatisfaction.
Causes of filler migration
As an anesthetic practitioner, it’s crucial to understand what causes filler migration in order to prevent it in patients.
Several possible factors can contribute to filler complications, including:
Injection Technique
Improper techniques, such as injecting filler excessively, injection under high pressure, or too superficially, can increase the risk of migration.
Over-treatment
If an area is over-treated with dermal filler, the tissue may be under too much tension. Therefore, the dermal filler migration may occur in an area of less stress.
Anatomical Variations
Variations in a patient’s facial anatomy (e.g., muscle movement and tissue laxity) can influence movement. This is whether the filler will migrate or not. If the dermal filler is placed in an area of high muscle activity, it may be displaced through the region’s dynamics.
Aftercare
Excessive massage of the site may force the filler from one area to another.
Effects of Filler Migration on the Patient
As any trained aesthetic practitioner will be aware, filler migration can cause absolute devastation to patients. From physical to psychological, filler complications can produce several adverse effects, including:
Uneven or lumpy Appearance
When filler migrates, it can lead to an uneven volume distribution, resulting in a lumpy or distorted appearance.
Displacement of Features
Migration may cause features to appear asymmetrical or disproportionate. You may be familiar with the term ‘duck lips.’ This usually occurs when filler migrates from the lips to the perioral region above them.
Chronic Inflammation
As the filler has displaced, this may cause inflammation of the surrounding tissues.
Psychological Impact
Patients may experience frustration, emotional distress, and a loss of self-esteem as a result of unsatisfactory results.
Preventing Filler Migration
Since we have now explored the potential impacts of filler migration, it’s essential to understand what we can do to prevent complications. There are a variety of undertakings to be made, from thorough patient assessment pre-procedure to meticulous injection techniques. Here’s how we can minimise risk:
Patient Assessment
Before the procedure, it’s essential to conduct a comprehensive assessment of the patient’s facial anatomy, skin quality, and aesthetic goals.
Proper Injection Technique
Ensure you always employ proper injection depth and placement techniques to prevent the filler from migrating from its intended location. Inject at a slow pressure and the right level. Avoid intramuscular injections and dermal filler at a much higher pressure or volume. In addition, use the needle that has been provided with your choice of filler. This will allow the correct and appropriate extrusion force for injecting, avoiding excessive pressure and tension on the tissues.
Use of Appropriate Fillers
Always select fillers with the correct viscosity and composition for the specific treatment area to minimise the risk of migration.
Limiting Movement
Patients should be advised to avoid excessive facial movements (e.g., vigorous chewing or facial massages) immediately after the procedure.
Post-Treatment Care
Always ensure you provide patients with post-treatment instructions. By including guidelines for facial hygiene and activities to minimise the risk of filler migration.
Resolving Filler Migration
In the unfortunate cases where filler migration has occurred, there are several viable options for correcting the issue and restoring the patient’s appearance to its former state, including:
- Hyaluronidase Treatment: Hyaluronidase is an enzyme that can effectively dissolve hyaluronic acid fillers, allowing precise correction of filler migration.
- Massage and Manual Manipulation: Gentle massage and manual manipulation techniques can help redistribute migrated filler and improve its integration with surrounding tissues of the face.
- Surgical Intervention: In very severe cases of filler migration, surgical intervention may be required to remove or reposition the displaced filler. Surgery tends to be needed when granulomas have formed and encapsulated the filler.
- Collagen Stimulation Therapies: Treatments that create lift, such as Sculptra, can augment areas affected by filler migration while improving skin quality in the long run.
Final thoughts…
By understanding the causes, effects, prevention tactics, and solutions for filler migration, aesthetic practitioners can minimise the risk of filler migration. And effectively manage it in the unfortunate event that migration should occur. By ensuring that rigorous patient assessment, consent, proper injection techniques, and attentive post-treatment care employed – you can rest assured that patient safety and satisfaction will be injected, along with the correct dermal filler for your patient.
To learn more about how to prevent filler migration and other cosmetic complications, check out our Complications Masterclass here.
