Lip Filler Migration: Understanding the Causes, Fixes, and Prevention
Lip augmentation using hyaluronic acid-based fillers can enhance the lips' volume and shape, creating a flattering pout. It's a swift and temporary procedure (lasting six to 12 months) with minimal recovery time (except for some swelling and bruising), which can promptly and significantly enhance the smile and the overall facial proportions. However, no aesthetic treatment is risk-free, and lip-enhancing procedures using fillers are under greater scrutiny than ever for migration – or what TikTok calls “the filler mustache.” The number of videos showing fillers seemingly moving out of place proves it's more common than many think.
In these clips, lip filler patients demonstrate how the product has moved into a space near the white roll of the lips (the small white line at the top) due to poor injection technique, excessive product, the lip's natural structure, or the wrong filler. This effect can also occur in other facial areas like under the eyes, but the lips are particularly prone to this spreading. Once the filler shifts, the lip, often the upper one, can look duck-like or distorted, an appearance no one desires.
If you're wondering if your filler is migrating, here's all you need to know to identify and restore a more natural look.
Why Does Filler Migrate?
Hyaluronic acid-based fillers are gels with a liquid-like consistency. The fundamental principles of science indicate that any liquid can move. Nevertheless, filler migration isn't necessarily an immediate consequence. Instead, it occurs gradually over weeks or even months or years. Not all 'temporary' fillers are truly temporary, and some mysteriously remain in specific areas, as stated by Paul Jarrod Frank, MD, a board-certified dermatologist and founder of PFRANDMD in New York City. The filler can move in almost any direction, though it typically happens more in the upper lip due to constant movement and actions such as smiling and talking. Consequently, the upper lips may have an odd appearance with visible product above the lip, causing it to protrude outward.
When fillers shift from their intended location, the result is lips that look unnatural, protruding or fuller in unexpected areas, according to Samuel Hahn, MD, a double board-certified facial plastic and reconstructive surgeon in Cockeysville, MD. The displacement often gives the impression of bulging or excessive fullness above or below the pink part of the lip called the vermillion border, creating a prominent shelf or an unnatural roll. Additionally, certain types of filler are more prone to pushing into that white space than others.
So, how can one determine if their filler has migrated or if it's just a case of poor lip injections? Firstly, examine the lip border. If there's a lack of a distinct perimeter between the lip edge and above or below the lip border or a swollen area across the upper lip cutaneous (vermillion border and philtrum), as mentioned by Madhuri Chadha, MD, the founder of Chadha MD Aesthetics in Beverly Hills. “This is what causes the 'trout pout' effect,” she adds. Other indicators to watch for include prolonged swelling or difficulty closing the lips. If the white part of the lip resembles a duckbill, then the filler has shifted and it's not over-projection, as noted by Ava Shamban, MD, a board-certified dermatologist in Santa Monica, CA.
Filler can migrate for one or more reasons. The most common ones include:
1. Incorrect Placement
Filler migration can occur when injectable products are placed in the wrong layer. As Dr. Hahn explains, a thin layer – known as the pars marginalis and pars peripherals – separates the lip muscle (orbicularis oris), and injecting into the wrong layer can enable the filler to move. By inserting more product into the lip, the path of least resistance for the filler is into the lip's peripheral tissues, leading to a deviation, he adds. Therefore, the depth of filler placement and the needles used are crucial for a successful outcome.
Depending on where the filler is injected, it can “migrate” into the white roll and even further into the cutaneous or white lip, as Dr. Shamban says. “The truth is, the product doesn't typically 'migrate' but ends up outside the intended area, mainly due to incorrect placement in terms of location or depth,” she explains.
Injectors use various techniques to inject the lips based on the patient's desired look, their natural lip shape and volume, and the inherent structure of the lips. Some popular injection techniques, like tenting and Russian lips, which create more volume in the middle of the lips for a heart-shaped appearance, claim to reduce the incidence of displaced filler. However, aside from being careful about how and where to place the product, there's no fail-safe method. “The outcome of lip injections is directly related to the technique and the original shape and size of the lip,” Dr. Shamban remarks.
2. Over-Injection
Filler migration can also result from over-injecting the lips. Movement can occur if too much filler is placed at once. Although there's no fixed amount causing a migration-like effect – even small amounts can shift – it's advisable to gradually increase the volume over time. But, as Dr. Frank explains, the features on the face are not much different from something like our shoe size. There's a limit to what can fit in a specific space. “People expect to achieve more with filler than what their natural anatomy allows,” he says. “Overfilled lips, nasolabial folds, and cheeks are due to overly aggressive filler use.”
Injecting too much product into the lips forcibly stretches them to accommodate the additional volume. Since the tissue can't hold the filler properly, it starts moving into neighboring areas. Injectors can control the amount of filler going into any area, which is why a less-is-more approach is essential. Dr. Shamban says that using specific techniques, such as microdosing the lips over multiple appointments, allows the product to adapt to the tissue. “We can assess the lip structure to enhance the appearance of size and shape or build the structure around the lips for a more 3D look without overfilling them,” she shares.
3. Wrong Product Selection
Not all fillers are the same, and using the incorrect product can cause it to shift beyond the injection area. Your injector must use the appropriate filler to ensure it stays in place. To start with, only hyaluronic acid-based fillers should be used in the lips – never Radiesse® or Sculptra®. When it comes to HA, “there is no ideal hyaluronic acid filler, but there are ones that are more suitable for certain facial areas to reduce lumping, bumping, and migration,” Dr. Frank notes.
4. Inflammation
Inflammation can occur as a natural response when a foreign substance is injected into the face. While an inflammatory response is not as common as poor technique or excessive product as the cause of filler extending beyond the lips, it can still happen. “There can be temporary inflammation, swelling, or a hematoma at the injection site,” Dr. Shamban says. Additionally, “it can also be attributed to a patient's reaction or an allergy to a filler, although this is rarer and an autoimmune response,” Dr. Chadha adds.
The bulging effect is most obvious when smiling or puckering the lips, but it can also be noticeable when the mouth is at rest. Some patients complain of a stretched feeling accompanied by discomfort depending on where the filler has moved. Although drifting filler is often more of a cosmetic issue, Dr. Chadha says it's important to address it promptly if certain symptoms are present. “Look for changes in color, skin blanching, pain, increased pressure, and continued swelling, all of which can be cause for concern and should be addressed by a medical professional,” she says. If the provider is not well-trained, follows improper protocols, or fails to ensure a sterile environment, Dr. Shamban says infection is also a concern.
How to Rectify Migrating Filler
There are two methods to fix migrated fillers:
Dissolve them with hyaluronidaseWait for them to break down and disperse naturally
For several reasons, the former is typically preferred. Dr. Frank states that the best way to handle migration is to dissolve the filler with hyaluronidase (an enzyme that breaks down hyaluronic acid gels). Within just a few hours, hyaluronidase softens the filler and restores the lips to a more natural shape, projection, and size. Not all of the filler necessarily needs to be removed. If it's only one area showing signs of migration, it can be treated selectively. Depending on the extent of movement, the lips may need to recover before reinjecting (if you choose to) to prevent recurrence. For most, this is a four- to six-week process. Patients who opt to dissolve and refill their lips need to proceed slowly and avoid overfilling, “as this could reopen the previous tissue planes that allowed for migration,” Dr. Hahn cautions.
Filler will naturally degrade for patients who do not wish to dissolve with hyaluronidase. Needless to say, this is a much lengthier process as the body may not completely break down all the product in the lips. On average, it can take anywhere from six to 12 months to disappear. Choosing this route doesn't mean every bit of the filler will vanish.
Migrated filler can be a one-time experience for some people and a persistent problem for others. “This means you might need to consider not treating that area with filler,” Dr. Frank says. “There are individuals who have a naturally higher tendency to migration due to their anatomy.” You might also want to seek a better-trained provider, as Dr. Shamban suggests. “Sometimes, the area around the lip needs to be filled for structure rather than the lip itself,” she notes. A skilled injector can make significant differences and improvements with the proper support structure.
Can Filler Migration Be Prevented?
There is no foolproof solution, but the best way to ensure that lip filler remains where you want it is to be injected by a highly skilled provider specializing in the procedure. “Generally, be concerned about your provider's experience level,” Dr. Shamban says. “The best practice is to do your due diligence and research your injector.” This includes their training and body of work. “Their aesthetic approach and results should be personalized and align with your look and aesthetics,” she notes.
While choosing the right provider is paramount for a successful outcome, there are other factors to be aware of when minimizing the potential for filler migration:
Understand what your injector is using. The only appropriate type of filler for the lips is a hyaluronic acid-based product, such as those within the Juvéderm® and Restylane® families. Although many different injectable brands exist, only HA fillers are safe for this area. Biostimulatory injectables, including Radiesse® and Sculptra®, should not be used in the lips.Appropriate filler viscosity is important. Using the wrong filler in the wrong layer of the lips can cause the product to shift. “The viscosity and density of the filler matter,” Dr. Hahn says. “In general, less dense, less viscous fillers are less likely to migrate.” Only your provider (not you) will know which filler is best for your lips.Take a less-is-more approach. If you desire fuller lips than what genetics gave you, a slow and steady approach is always best. “It's better to do small increments at a time rather than overstuff an area,” says Dr. Frank, who also suggests that injectors be attentive to ensure patients' expectations are reasonable. “Follow-up and retreatments are beneficial,” he shares. “It's also helpful to check in with patients every few months to assess the work done whether they are getting refilled or not because even the best filler placement can sometimes change in position.”The injection technique is crucial. Probably the most important rule for your injector to follow is proper product placement. Dr. Hahn says that while the amount of filler injected plays a role, the technique and placement of the filler are equally important to prevent migration. For instance, he says it's essential to inject filler close to or at the vermillion border, which precisely outlines the cupid's bow. Otherwise, the filler can migrate into the surrounding tissue. “In general, the more filler injected, the higher the chance of migration,” he adds.
Beyond Filler
If filler migration becomes a recurring issue or you want to avoid the risk altogether, there are other surgical and non-surgical lip-enhancing procedures to consider:
Lip Lift: The trending lip lift procedure is a permanent way to enhance the lips. The procedure shortens the distance between the upper lip and nose to reveal more of the pink part of the lips. Keep in mind that the main goal here is to address the shape of the lips rather than add volume, although your surgeon can achieve this by adding fat during the surgery.Lip Flip: A lip flip utilizes neuromodulators (i.e. Botox®) instead of filler (though many injectors choose to combine the two). Dr. Shamban says lip flips can be performed in a similar but distinct way to improve lip size and shape. By relaxing the muscles around the lips, the lips flip (hence the name) outward to make them appear more pouty. This technique is also helpful for those with thin lips or a gummy smile.Fat Transfer: Autologous fat can be used to add volume and fullness to the lips when they are naturally thin, prone to filler migration, or not as responsive as desired to synthetic injections. Lip augmentation with fat transfer is usually carried out along with other surgical procedures (such as a facelift), as liposuction at a donor site must first be performed to harvest the fat. After the initial absorption period, the results are long-lasting and the shape and volume can be corrected.
The Conclusion
If you suspect your lip filler is moving – whether it's days, weeks, months, or years after your injections – you might not be imagining it. Fillers that are injected incorrectly or not suitable for the lips can end up migrating outside the vermillion border, resulting in a ‘trout mouth’ or ‘duck lip’ appearance. While there's no guaranteed way to prevent this from happening, choosing an expert injector is one of the best ways to ensure an ideal outcome.
