Dermal fillers:
48 questions about what goes where

What should I do if a nose thread lift has gone wrong?

Do not pull, cut or squeeze a thread end. Pain that increases, spreading redness, discharge, blanching or any change in vision needs same-day review. Otherwise book an assessment: an exposed thread end is usually trimmed or drawn out and the point cleaned, infection is treated medically, and a quiet thread in the right plane is often left to resorb. The nose thread lift gone wrong guide sets out each problem.

Can filler migrate years later?

Yes. Filler can be found away from where it was placed long after the injection, and migration is sometimes noticed only when swelling or a lump draws attention to it. Ultrasound shows where the filler sits now and how deep. Hyaluronic acid can be dissolved with hyaluronidase placed into the deposit; calcium hydroxylapatite, polycaprolactone and other non-dissolvable fillers need a different plan.

How long does hyaluronidase take to work?

Hyaluronidase starts to break down hyaluronic acid as soon as it reaches the filler, so placement matters more than waiting. How quickly a change shows depends on how much filler there is, how it is cross-linked, how deep it sits and whether the enzyme reached all of it, which is why ultrasound guidance helps. Swelling from the injection can hide the change at first, so the result is judged at a review.

What are the different types of dermal fillers?

Two broad groups. Hyaluronic acid fillers occupy space, hold water and can be dissolved with hyaluronidase. Biostimulators (Radiesse, Ellansé, Sculptra) prompt your own collagen and cannot be dissolved.

Can dermal filler be dissolved?

Hyaluronic acid filler can, with hyaluronidase. Calcium hydroxylapatite, polycaprolactone and poly-L-lactic acid cannot be dissolved by enzyme and are resorbed over time; Dr Sin Yong treats lumps from them with the Sculpting mode of Time Freeze Laser LCLR®, without an incision. Ultrasound guidance directs the enzyme at the misplaced product rather than the whole area.

Which filler can be reversed?

Only hyaluronic acid filler can be broken down with hyaluronidase. Firmer, more cross-linked gels respond more slowly, so dissolving is often staged with a review in between.

What is pillow face and how does it happen?

The rounded, heavy look from too much filler, usually layered over product still present until the total exceeds what the facial skeleton supports. It is treated by dissolving the excess under ultrasound guidance and reassessing the face from the beginning.

Does filler really migrate?

It can. Published reviews describe filler found outside the plane where it was placed, weeks to years after injection, more often in mobile areas such as the lips. Not inevitable, but a recognised finding rather than a myth.

What is a vascular occlusion and how would I know?

Filler entering or compressing an artery and blocking blood flow. The signs are skin that blanches or turns dusky or mottled, pain out of proportion and, rarely, any change in vision. It is an emergency: urgent assessment by the doctor who injected you, or at A&E, now, and for any change in vision or eye pain, call 995 now; hyaluronic acid is treated with high-dose hyaluronidase.

Which type of filler is used for the nose?

Here, usually calcium hydroxylapatite or polycaprolactone for the support they give the bridge, with hyaluronic acid where a dissolvable option is preferred. The nose carries a higher vascular risk, which shapes technique and quantity.

Is there a right age to start dermal fillers?

No. Filler follows anatomy rather than age: a retruded chin or low nasal bridge can be addressed in younger adults, while fat-pad and bone volume loss appears later. The useful question is whether volume is genuinely missing.

What is the difference between Sculptra and Ellansé?

Both stimulate collagen. Sculptra is poly-L-lactic acid microparticles whose effect builds gradually; Ellansé is polycaprolactone microspheres in a gel, giving volume on the day and stimulating collagen as the gel is absorbed.

“Filler adds volume; it does not lift, and more of it does not fix what too much of it caused.”

Dr Sin YongOn filler and overfilling

Should I get all my filler dissolved at once?

Usually not. Filler accumulated over years has become part of how the face is supported, and removing it in one sitting can uncover laxity and hollowing. Correction is staged by region and reassessed between stages.

Can dermal filler lift sagging skin?

No. A filler occupies space to restore volume or projection; it does not lift tissue, tighten loose skin or act on muscle. Given to a face whose main change is descent, it produces a heavier lower face with the same sag, so laxity is assessed for lifting instead.

Is a cannula safer than a needle for filler?

A blunt cannula pushes vessels aside rather than piercing them, which is why it is often chosen for the tear trough and temples. A fine needle is used where the anatomy calls for deep placement on bone, with aspiration and slow injection. The choice is made area by area; neither removes risk.

Why is ultrasound used before filler treatment?

To show where existing product sits and at what depth. Ultrasound separates filler from swelling, fluid and your own tissue before anything is decided, so any dissolving is directed at the misplaced product rather than guessed at. It also shows calcium hydroxylapatite clearly.

Which areas of the face are highest risk for filler?

The nose, the glabella between the brows, the forehead and the tear trough, because arteries there connect with the circulation of the eye. No area is free of risk, which is why product is placed in the planned layer in small amounts at low pressure.

How do I tell a bruise from a vascular occlusion?

A bruise is blue or purple where the needle went in, tender but not disproportionately painful, and the skin over it refills when pressed. An occlusion blanches white or mottles along an artery's territory, hurts more than it should and worsens over hours instead of settling. That needs urgent assessment by the doctor who injected you, or at A&E, now.

What should I do if my skin turns white after filler?

Get urgent assessment by the doctor who injected you, or at A&E, now. Do not wait for it to settle. A change in vision or eye pain after filler: call 995 now. Tell the doctor what was injected, where and when.

Can dermal filler affect my eyesight or vision?

Very rarely, yes, when filler travels into an artery connected to the eye, most often with injections around the nose, glabella and forehead. Blurring, loss of vision, double vision or eye pain after filler is an emergency: call 995 now.

Can I be allergic to hyaluronidase?

Yes, rarely. Hyaluronidase is a medicine with its own considerations: a known allergy to it or significant reactions to bee or wasp stings are asked about beforehand, and patients are observed after injection. It also acts on the hyaluronic acid naturally present in tissue.

How can I reduce bruising after filler?

Declare blood-thinning medicines and, if medically appropriate, avoid alcohol and supplements that increase bruising, such as fish oil or vitamin E, in the days beforehand. Afterwards, avoid strenuous exercise, heat such as saunas and alcohol for about a day, and do not press on the area.

Can I have filler while pregnant or breastfeeding?

Filler is deferred in pregnancy and breastfeeding because its safety in these groups has not been established and the treatment is elective. It is also deferred with an active infection or cold sore near the site. A consultation to plan the order of treatment afterwards is still acceptable.

Why does tear trough filler sometimes cause puffiness?

Hyaluronic acid draws water into itself. Placed near cheek mounds that already drain poorly, it can deepen swelling that is then hard to reverse. Filler helps a hollow along the bony rim; it does not help fluid, a fat bag or thin crepey skin, which is why the cause is examined first.

Can tear trough filler make eye bags worse?

Yes. A true eye bag is a bulge of orbital fat, and filler is for hollows. Placing volume beside the bulge tends to blend bag and groove into one larger mound, so the lower lid looks heavier. A large bag is referred to a plastic surgery or oculoplastic specialist instead.

What is the Tyndall effect after filler?

A bluish tint where hyaluronic acid gel sits too close to the surface under thin skin and shows through it. It is commonest under the eyes, where the skin is among the thinnest on the body. Because the product is hyaluronic acid, it can be assessed and dissolved if needed.

Is a lump after filler normal?

A lump in the first weeks is usually product or swelling. A firm nodule appearing months or years later can be an inflammatory reaction such as a biofilm or granuloma, which needs examination rather than massage. A lump that is red, warm, tender or growing needs a doctor the same day; if no doctor can see you today, A&E.

Why do my cheeks look puffy after filler?

Puffiness after filler is not one problem but four: filler placed too superficially, filler that has drifted, fluid the filler is holding, or simply more volume than the face needed. Each looks different on ultrasound and each is handled differently, which is why they are separated first.

What can be done about a Radiesse or Ellansé lump?

It cannot be dissolved, because hyaluronidase has no effect on calcium hydroxylapatite or polycaprolactone. The first step is ultrasound to establish what the lump is, how deep it sits and how long ago the product was placed. Options then range from monitoring and targeted injections to the Sculpting mode of Time Freeze Laser LCLR®, without an incision.

What is the difference between filler and a skin booster?

A filler occupies space to restore volume, projection or contour. A skin booster acts within the skin on hydration and quality and does not project or contour. Botulinum toxin, the third injectable, relaxes muscle. Which fits depends on which tissue is responsible for the change you notice.

Do I need to declare old silicone or other non-resorbable filler?

Yes. Layering new product over earlier non-resorbable filler raises the risk of nodules, so it must be declared. Where the history is unclear, previous filler of any type is scanned with ultrasound before anything is added, and removal of older non-degradable material is a more involved discussion, though Dr Sin Yong treats lumps from it with the Sculpting mode of Time Freeze Laser LCLR®, without an incision.

Is it normal for filler to look uneven at first?

Often, yes. Swelling settles at different rates on the two sides, and lips and tear troughs swell more than bony areas, so temporary asymmetry in the first days is common. It is not a reason to add more product; the result is judged at review once swelling has settled.

Where does migrated filler most often show up?

Under the eyes, where it reads as puffiness; in the lips, as a soft shelf above the lip border or lumps away from the injection point; and around the nose and chin. Each deposit is located first, with ultrasound where useful, and then treated deliberately.

Why do I have a lump under my eye after filler?

Usually hyaluronic acid placed too close to the thin eyelid skin, swelling trapped above the malar septum, or old filler that has persisted for years. A new tender lump months later is a delayed-onset nodule and needs a doctor the same day; if no doctor can see you today, A&E.

Why does my tear trough filler look blue?

That is the Tyndall effect: hyaluronic acid sitting too superficially shows through the thin skin as a bluish tint. It is treated by dissolving that superficial deposit with targeted hyaluronidase.

How common are problems after tear trough filler?

In one series of 583 patients and 1,452 tear trough treatments, swelling occurred in 10%, contour irregularity in 4.6% and a bluish tint in 3.3%; larger volumes raised the risk of swelling.

Why are my eyes puffier years after filler?

Hyaluronic acid can persist for years and draw in water, and filler above the malar septum can trap fluid. Fluid and retained filler are told apart before anything is dissolved.

Can Sculptra, Radiesse, Ellansé or Juvelook lumps be dissolved?

No. Hyaluronidase dissolves only hyaluronic acid. These collagen stimulators are assessed with ultrasound and managed case by case; Dr Sin Yong uses Time Freeze Laser LCLR® Sculpting mode for excess material, including under the eye.

Why do I have a lump years after filler?

It may be an inflammatory reaction, a biofilm, a granuloma, or old filler that has swollen or moved. The name delayed-onset nodule describes timing, not cause, so it is investigated before treatment.

What is Juvelook?

An injectable collagen stimulator made by VAIM: poly-D,L-lactic acid microspheres with non-cross-linked hyaluronic acid. Hyaluronidase dissolves its hyaluronic acid but not the PDLLA.

Is Juvelook the same as Sculptra?

No. Juvelook uses amorphous PDLLA microspheres in hyaluronic acid; Sculptra uses semi-crystalline PLLA particles in carboxymethylcellulose. Laboratory work found Juvelook particles smaller and spherical.

How do you get rid of pillow face?

When the filler is hyaluronic acid, by dissolving the excess selectively with hyaluronidase after ultrasound mapping, in stages, then reassessing before any support is added.

Does pillow face go away on its own?

Usually not quickly. Hyaluronic acid filler can persist for years and draws in water, so an overfilled look often stays or grows with further top-ups.

What happens at a dermal filler visit?

The first visit is an assessment of the whole face, not a treatment. Treatment follows a written plan naming the material and the areas, small amounts are placed and checked side against side, and a review follows once the swelling has settled.

What should I expect at a Sculptra or Ellansé visit?

A planning visit comes before a placing one: earlier injectables are mapped with ultrasound, the product is placed deep and deliberately under-corrected, and the face is judged at review, because collagen sets the pace and neither product can be dissolved.

What is the downtime after dermal filler?

Mostly swelling and the chance of a bruise, and both depend on where the product went: lips and tear troughs swell more than areas where filler sits on bone. Skin that turns white, dusky or mottled, or worsening pain, needs urgent assessment by the doctor who injected you, or at A&E, now; any change in vision or eye pain: call 995 now.

What does recovery after Sculptra look like?

The face looks fuller on the day because the poly-L-lactic acid is suspended in water; that fullness fades and the face returns close to its starting point while collagen forms slowly. A lump that is growing, red, hot or painful is not part of normal recovery and needs a doctor the same day; if no doctor can see you today, A&E.

What is normal after Ellansé?

Swelling, tenderness, a possible bruise and a temporary firmness where the gel carrier sits, all of which settle on their own. A growing lump, spreading redness or heat needs a doctor the same day; if no doctor can see you today, A&E. Increasing pain or a change in skin colour needs urgent assessment by the doctor who injected you, or at A&E, now.

Am I suitable for dermal fillers?

Usually when the change is a genuine loss or absence of volume, in a face whose skin and ligaments still give support, and you are not pregnant, unwell or carrying an active infection near the site. The whole face is examined before that is decided.

Who is Sculptra suitable for?

Broad, diffuse deflation of the temples, midface or lower face, in skin thick enough to hide a particle, in someone who can wait for a gradual result that cannot be dissolved. It is not used for the under-eye, lips or fine lines, or in keloid-prone skin.

What aftercare is needed after Ellansé?

Mostly leaving the area alone: no massage unless you have been told to, no pressing, heat, alcohol or hard exercise on the first day, and sleeping face-up with the head raised. A lump that is growing or hard is examined with ultrasound rather than rubbed; one that is painful needs a doctor the same day, or A&E if no doctor can see you today.