It happens every time: I look at before and after photos of women who have had lip fillers, considering a date. Then, as social media algorithms are designed to do, I delivered videos full of warnings: “Filler migrates! It never dissolves! Look how disfigured the faces of these people are now! Voices scream at me as I’m shown MRI scans of filler drops that have migrated from someone’s cheekbones behind their eyeballs.
That’s enough to scare anyone off from the seemingly straightforward procedure, but with dermal fillers becoming so ubiquitous, it can’t be as bad as these videos try to make us believe. Right?
What is infill, anyway?
Loads are injected into the face to create a variety of looks, to add volume where it has been lost with age or where it never existed. They plump lips, enhance cheeks, smooth smile lines and outline jaw lines.
Understand that “skin filler” comes in many forms. There are different brands, and within those brands are unique formulas, but the most commonly used are short term fillers like Juvederm and Restylane. These are mainly made up of Hyaluronic Acid (HA), an ingredient naturally present in our skin which has been modified to create a more stable and long-lasting substance.
“Overall, HA fillers have become the material of choice due to their favorable properties: safe, durable, non-immunogenic, and cost effective,” said Samuel Lin, associate professor of surgery at Harvard Medical School and a certified plastic. by the board of directors. surgeon. In the event that something is wrong or the patient does not like the end results, a solution called hyaluronidase can be used to dissolve the load.
Although the fillers can cause temporary swelling, they are approved by the Food and Drug Administration and are considered safe, with few side effects or known long-term consequences. The key phrase here is “known long-term consequences”. If you want to know exactly how many tests a particular filler has undergone to receive approval, the FDA is publicly sharing data on dermal fillers. (For example, you can read the entire Juvederm Voluma testing methodology.) Ultimately, if you are not comfortable with testing a product, the decision is yours. And always be sure to see a dermatologist or certified plastic surgeon.
How long do the charges last?
For those who want the convenience of a temporary charge, the marketed lifespan of these short-term charges is six to 12 months (depending on the charge used and the individual’s lifestyle). But while the filler itself is considered safe to use, what about all those sticky filler claims years later?
This is no surprise to Dr. Anil Rajani, who specializes in minimally invasive aesthetics (and often talks about filling on his YouTube channel). “In terms of longevity, there is no doubt that these fillers last longer than what approval studies track for the duration of the effect,” Rajani said, referring to the fillers he has dissolved for years. after the injection.
So why are we being told differently? Rajani says it comes down to the FDA approval process, which looks at safety and duration, which studies run for about six months to two years. In these studies, the amount of product remaining in the face is based on the external appearance, not an actual tissue sample of what is left in the body.
“People think the product is totally gone after a year, which is wrong,” Rajani said. “In fact, the filler can stay in the body for several years, and this is demonstrated by recent breakouts on people’s faces after receiving the COVID-19 vaccine,” he said, referring to a few patients who experienced swelling in some areas with filling. In one case, the patient had obtained the filler years earlier. “Personally, I dissolved the putty in my eye area from the product six years ago,” Rajani said.
The body begins to absorb the load in about four to six months, Lin added. “However, it is not uncommon for charges to last much longer (one to two years), depending on the location, the brand of charge used and the injection technique.” The amount of filler injected and the body’s metabolism also make a difference, and because hyaluronic acid fillers can absorb water, they can make them more visible.
How and why does the putty migrate to other parts of the face?
When it comes to those scary MRI scans (which are the exception, not the norm), there are many factors that explain why the filler can end up beyond where it was injected.
“A high volume of injected charge and an injected charge in high pressure areas can lead to overflow of the charge into adjacent areas with lower pressure,” Lin explained. In the case of lip fillers, this can lead to a “filler mustache”, where the filler injected into the lips spreads above the mouth.
But just because the infill has migrated doesn’t necessarily mean it will cause damage. And if it does – possibly by becoming infected or forming nodules – the filler can be dissolved with hyaluronidase. “The low amounts remaining in the body did not turn out to be a problem,” Rajani said. “Because it’s in such small amounts, it’s not visible to the human eye. So at this point there are no known long term side effects but we are still monitoring. “
Lin agrees. “Load migration and loads that last a long time don’t necessarily indicate something dangerous.”
While charges are generally safe, they are not without risks. But these risks – such as being injected by an untrained supplier or by someone using unapproved or “black market” fillers – can be mitigated by going to a licensed professional with extensive training. “Finding the right plastic surgeon or dermatologist to perform your skin filling procedure and optimize your safety is essential,” said Lin. During your consultation, ask questions about the procedure and the filler used, and make sure you feel comfortable before proceeding.
The issues that fear-mongering content creators warn are not totally unfounded, but their message may be overstated. Load migration is real and the lifespan of these loads may exceed their marketed lifespan. But a supplier who knows what they’re doing can turn those into non-issues and, most importantly, do it safely.