Search for "#lipfillermigration" on TikTok — a hashtagwith2 million+ views — and you'll find a mix of cautionary tales, informational videos, and vlog-style "come with me to get my migrated filler dissolved" posts. Judging by those videos and their popularity, plenty of people are curious about or have thoughts on lip filler migration.
While scrolling through the social media videos is a quick and easy way to gather info, their facts aren't always necessarily accurate. If you'd rather get a streamlined explanation of lip filler migration with insight from the pros about its causes and whether it can be prevented, keep reading.
Lip filler is a cosmetic procedure that involves injecting a gel-like substance into your lips to add temporary fullness or aid in hydration. And as the name suggests, lip filler migration occurs when filler moves to a different location from where it was intended post-injection.
The issue doesn't seem to be super common, but the exact rate of lip filler migration is somewhat of a mystery. "It is not something I see often, but it can happen," says Rebecca Marcus, M.D., a New York-based board-certified dermatologist and founder of Maei MD. "It's hard to put a statistical rate on it, it's relatively uncommon," echoes Amir Karam, M.D., a San Diego-based board-certified facial plastic surgeon.
The filler isn't traveling far, according to Kay Durairaj, M.D., F.A.C.S., a Pasadena, California-based facial plastic surgeon. "The typical scenario is that the filler will migrate just beyond the border of the lip, which is called the vermilion border, and it goes into the skin or cutaneous portion of the lip," usually in the top lip but sometimes the bottom lip, she says.
Mild migration can create a subtle "ledge" beyond the border of your lip, while more noticeable migration can create more of a "shelf" or "plateau where you have almost a 'filler mustache' and you have a side projection that looks more ducky," says Dr. Durairaj.
In other cases, lip filler migration can create lumps on the wet-dry border of the lips, according to Dr. Durairaj.
Several factors can lead to migrated lip filler, ranging from injection method to materials used.
Administering lip filler is an art, and certain injection techniques are more likely to result in migration than others. The most common culprit seems to be the "Russian lip technique," says Dr. Durairaj.
The technique "has become trendy" since it creates a three-dimensional, Bratz Doll-esque result, but that can come at a cost, says Dr. Durairaj. "It involves multiple punctures of the border of the lip and that makes your lip very prone to filler leaking out of those puncture sites [and]migrating," she says. "You're violating this little thin membrane repeatedly and so it becomes like a garden hose that springs a leak because it has multiple little holes at the top edge of it."
An injection technique that uses fewer incisions, therefore creating fewer "holes" in the "hose," will be less likely to result in migration, says Dr. Durairaj. Creating fewer punctures on the border of the lip is always the cleanest and best technique, she adds.
Injectors can choose from various types of dermal fillers depending on the area they're injecting and their patient's intended results. Hyaluronic acid fillers in particular are the most common pick for the lips. Hyaluronic acid is a sugar molecule that naturally occurs in your body and can absorb water like a sponge, which is why it's a mainstay in topical skin-care products.
Even though migration can occur with hyaluronic acid filler, injectors still tend to favor it for the lip area over options (e.g. calcium hydroxyapatite or poly-l-lactic acid fillers) for multiple reasons. "Hyaluronic acid will give the most natural look, and it's also reversible in the event that a patient is less than thrilled with their results," says Dr. Marcus. Your provider can inject hyaluronidase, an enzyme that breaks down hyaluronic acid if you want to dissolve your lip filler.
The fact that hyaluronic acid — unlike other types of filler — can be reversed is a major draw when it comes to treating the lip area. "Hyaluronic acid fillers are the only filler category that I would suggest putting into the lips, primarily because lips are highly vascular [i.e. home to many blood vessels]," says Dr. Karam. If an injector accidentally injects filler into a blood vessel, there's a risk of necrosis (death of the tissue), he says. If hyaluronic acid filler was used in this scenario, the provider can inject hyaluronidase to prevent necrosis.
The downside to hyaluronic acid's water-absorbing quality is that it can contribute to lip filler migration in some cases. "Lip filler migration is generally a result of the fact that hyaluronic acid fillers absorb water, and they can begin to create some extra volume and extra absorption of volume in areas that were outside of the primary injection site," says Dr. Karam. "This is not always a direct result of how it was injected — oftentimes it can just simply be because of the nature of the hyaluronic acid filler. [Injectors are] learning more and more that the filler can travel and migrate to regions outside of the injection site. This can happen months or up to years after the injection."
"Certain fillers are rumored to cause more swelling and draw in more water — they're more hydrophilic," says Dr. Durairaj. Fillers within the JUVÉDERM family are more hydrophilic than Restylane fillers, but injectors should take a variety of other factors into account when choosing the best filler for a particular patient, she says. For example, a more hydrophilic option may be better for someone with a very thin lip, says Dr. Durairaj.
Filler is priced by the syringe, and migration usually occurs when someone's had more than one syringe of filler injected in a single appointment, according to Dr. Durairaj. "In my practice, I'll only ever place one syringe per visit, just because I think the lips can only physically hold so much volume," she says. "I think unfortunately there are many med spas that are geared up to just really make revenue and they will do what the patient asks. So if a patient does not want to come back and forth several sessions and just wants speed and convenience, they'll just put two syringes at a time."
Your starting point is also a factor. "People who have very thin upper lip, or who have an "M"-shaped lip with a very thin cupid's bow are [more] prone to filler migration," says Dr. Durairaj. "And because they have a small lip envelope to fill and in order to get a classically beautiful appearance, [injectors] want to fill the bottom and top lip."
Simply moving your lips while talking and eating can contribute to filler migration, according to Dr. Durairaj. "It's important to understand that even when you go to someone who's done great work, you can still have filler migration because the lips are circular muscles. The more that they are pursing [their lips], and using a straw and doing certain actions, sometimes the filler tends to be propelled outward," she says. The reason that filler migration occurs in the upper more oftenthan the lower lip is "due to the fact that you tend to move your upper lip more than your lower in speech," says Dr. Marcus.
If you've experienced lip filler migration and don't like the way it looks, don't hesitate to book an appointment to have your filler dissolved, recommends Dr. Durairaj. "Whenever I see filler migration, I recommend hyaluronidase," she says. "...People think that they should wait until the filler dissolves and in reality, it takes an extremely long time. It can take two to three years and beyond. I also don't like the idea of injecting good filler on top of bad filler placement because it's hard to camouflage and truly just draws more water into the problem migration area."
When you decide to try out lip filler, "there is always a chance" migration will occur, says Dr. Marcus. "However, choosing an experienced provider minimizes the risk of adverse events and undesirable results." Try to find a provider who has a high-volume practice and place stock in word-of-mouth referrals over Instagram posts, as social media photos can be Photoshopped or even stolen from other sites, says Dr. Durairaj.
To avoid migration from overfilling, take a slow and steady approach, says Dr. Durairaj. "The typical lip filler syringe is expected to last at least one year, and mostly [injectors are] finding that it lasts a lot longer than that. Being sure that your lips have settled down before you add another syringe is a great idea," she says. "For people who want a very full look, I would recommend doing one syringe every month or two months to gradually layer it in as opposed to placing more than one syringe at a time."
You might consider trying a "lip flip" as a way to dip your toe in the lip augmentation waters. "A lip flip is another option for increasing the appearance of fullness in the lips," says Dr. Marcus. The procedure involves the injection of a neurotoxin (e.g. Botox) in a location that causes the upper lip to flip outward a bit so that more of the inner part of the lip shows, she explains. "This procedure does not last as long — about three months — and is almost always less expensive than lip filler, so it may be an interesting 'stepping stone' for the right candidate," she says.
Even given the possibility of migration, a lot of people turn to lip filler —and plenty of them walk away satisfied with their results. "Lip fillers are probably, generally speaking, the best treatment for volumizing the lips," says Dr. Karam. "It just has to be done conservatively and has to be done in well-trained hands."