Filler Migration Myth

The illusion of filler migration is like a paradox in aesthetics. Any time you see a place advertising ultrasound to see where your filler migrated… stop and ask yourself if you actually need it.  First, and foremost, dermal filler is somewhat meant to migrate. It is not concrete. It is flexible and thank God for that. From the moment we put it in… it migrates to the local area of least resistance. Most common fillers are water-based gel formulated, with HA molecules cross linked. It moves under hydrostatic pressure around vessels, skin layers, and nerves. Dermal filler has a degree of cohesiveness. Meaning, it sticks. Therefore, migration past the first few hours while it integrates under normal circumstances is not common. 

So here is a twister. Dermal filler is occasionally used in off label locations for off label indications. This can prelude another injector to interpret or present it as “migrated”.  For example: filler in the perioral area.  Occasionally, this technique is warranted to treat depressions and weak areas above the lips. When injected appropriately, it provides an anchoring, skin boosting effect.  This is only for the purpose of correction, not changing what you look like. This is an off-label indication. But because filler may be labeled precisely for lips, others may not be comfortable and experienced enough to venture from those areas.  This scenario presents an opportunity for them to call it “migrated.” And they will take your money to tell you that. If you call the original injector and tell them there’s filler there in that spot… the answer from them would likely be… “well no 💩”.

Many licensed and experienced professionals, like me, have ultrasound equipment.  However, it is only used to follow up on suspected complications.  This is incredibly rare, especially in educated and experienced hands.  But that cohesivity factor I mentioned earlier… can get stuck in vessel walls if improperly placed.

That leads me to the ads for filler reversal under ultrasound. Please understand that we use an injectable, water based, non-cohesive enzyme to reverse filler without needing ultrasound. It works like taking a water hose to a fire. In a true emergency, nobody should have the time to be sold on an ultrasound. The ultrasound is used as a clinical tool should the reversal fail or the patient has ongoing problems. But it’s not necessarily in the first line in treatment. I have 11 years of experience with zero vascular compromise clients.  Therefore, I’m not convinced these cases are common enough in normal practices to have a wide enough audience to advertise ultrasounds for filler reversal.

Being overfilled is another scenario that may need reversal, but again, you don't need ultrasound for that. The injector should know and document the exact anatomical location, plane, and amount of filler placed. Easy reversal.

So. Unless you are having unresolvable filler problems, please do not feel the need to run out and spend your hard-earned money on an ultrasound advertisement. Having said that, if you had work done under questionable circumstances like unqualified persons, drug origin unknown, etc., it may not be a bad idea to have an ultrasound. That is very understandable. But otherwise, you are likely doing it just for the heck of it. That's ok too as long as you completely understand this!