The Hidden Truth About Lip Filler Migration
Lip filler migration is still here—probably more prevalent than ever. And I actually think it's one of the main reasons why so many people hesitate to get dermal fillers in the first place. But don't worry, because today I'm going to share with you all the reasons why it happens and everything you need to know in order to help prevent that from happening to you.
Reason One: The Annual Refill Myth
Let's begin with the first and most common reason. Many medical aesthetics providers are told by representatives and companies that lip filler—or any hyaluronic acid filler—tends to break down fully after about a year. The story goes that your body excretes it, and you're free to replenish annually. But that's really not the case, and you shouldn't be doing that. Lip filler, or any hyaluronic acid filler, tends to lose its shape after about a year, but what actually happens is that the hyaluronic acid ends up breaking down and integrating into the tissues. It integrates into the skin, superficial fat pads, deep fat pads, and sometimes even into the muscles. As a result, it acts like a long-term synthetic hydrator.
If you use a mild to moderate amount, that could actually be great—maybe after one round and then a couple of minor top-ups, you might have all you need for several years. The problem arises when people are under the impression that you need to refill with almost the same amount of product annually, without dissolving the old filler first. When that happens, not only does the filler integrate into the tissues, but it backs up and builds up. As a result, your lips start changing from a nice, hydrated, plump look to a hydrated, plump lip that sticks out like this—because all this volume is now too much and it's backed up.
Reason Two: The Constant Movement of the Mouth
Hyaluronic acid dermal fillers will move if placed in an area with a lot of movement. When you look at the face, the most movement is certainly around the mouth. Everything you do—talking, eating, chewing—causes that filler to move in micro-increments daily. As a result, some people come back after three or four months saying, "I swear my body just ate it all—I don't even see it anymore." But what's really happened is that the filler has likely moved from the front of the muscle to either on top or underneath. That movement comes from the muscles gripping it and shifting it back, oh so slightly.
There are things you can do to help with that. I usually recommend a little bit of neuromodulator around the mouth to minimize some of the movement, and that can help too.
Reason Three: Injection Technique and the Borders You Must Not Cross
Now, I'm not saying you should blame your provider when it comes to migration of lip filler, because most of this happens for multiple reasons. For example, consider the dry border of the lip—the red part you see is called the Vermilion. The border on top of it is called the Vermilion border, also known as the white roll. When you flatten the lip, you'll see a little white line right there. This border separates the ergotrid (the part above) from the Vermilion. The second border is the wet-dry border, which is the line between the dry part and the wet part underneath. These are two different borders that you do not want to cross or break whenever you're doing lip filler injections, if you want to decrease your chance of migration.
For instance, the lip tenting technique, if done poorly, can cause two different types of lip filler migration in one setting. The tenting technique goes from the top to the bottom. It's encouraged to usually place drops at the bottom—that could be at the wet-dry border or just inside the wet border if you want to help create an M-shaped lip. But this can cause migration underneath. And whenever you're placing the needle in, if you're coming from the Vermilion border or just on the outside, guess what? The filler will travel up that channel and migrate outside of the lip.
Another way to cause migration is depth. If you're placing filler too deep into the muscle, you're already placing it in an area where the muscle is going to grip it and move it back into an area of least resistance. This muscle is thinner and weaker than that muscle, so if you're placing it too far back, it's just going to migrate right away. These are all different variables. There is no one technique that's better than others—this is very much a personal choice with regard to aesthetic look. However, there are certain things you can do to decrease your chance of lip filler migration, if it's really important for you.
Reason Four: The Brand and Rheology of the Filler
The brand and the rheology of the filler we use in the lips—rheology is just a fancy word for the type of lip filler we're choosing. Every brand has a line of fillers ranging from very thin to very thick, and everything in between. It's our job to choose what's appropriate for that client, considering both brand and thickness, because they all vary. Some brands don't draw in a lot of water—what you see is what you get. But other brands tend to draw in a lot more water, sometimes 30% more water than what you see visually. So if you're going to fill a client who says, "I really want a nice, juicy, plump pout," and you feel like this is as much as you can handle, but you used a brand of filler that draws in a lot more water, and you've already maxed out their lip—well, guess what? In six months, it's going to migrate. There's no room for it at the front, so it will migrate to the back. With one setting, you can have visible lip filler migration. That's something you definitely need to consider: choosing the right brand and filler rheology.
Reason Five: The Dangerous Temptation of Overfilling
This leads us to the fifth reason: intentionally overfilling the lip to try and expand it. Listen, that is a bad idea right off the bat. The lip is just like the skin. If you stretch it out intentionally, you are literally aging your skin by 20 to 40 years within months. What you're doing is asking it to bypass the flexibility, the elasticity—everything you're building, which is your type one and type three collagen that keeps your skin firm and youthful. You're basically pulling it and stretching it apart to the point where it can't function anymore. As a result, it gives, and then you can grow the lip. But you really don't want to do that, because first of all, it takes several attempts to actually grow the lip, and with your first couple of attempts, you're asking for migration right away. As I said before, if there's no room for the lip filler, it's either going to expand the lip or it's going to migrate back, and it usually does both at the same time.
Be mindful of that. Don't overfill your lip. What you're looking to do is just enhance your lip slightly to moderately. That way, you will have a real nice, consistent lip with a nice little plump that's not going to give you headaches later on. The worst-case scenario is that you've expanded your lips to the point where you have to keep them inflated, otherwise they'll just look shriveled. This is very similar to what people did when they expanded their earlobes—they put spacers in, expanded them, expanded them, and then whenever they were 40 or 50, they stopped doing that and regretted it because they had this huge, hanging earlobe. The only way to fix it is surgery, and surgery for the lip for that never looks good.
So take care of your lips, respect their natural boundaries, and choose your approach wisely. Migration is not inevitable if you understand the science behind it.