Refining, Revising: Understanding Filler Revisions and Redos

In the hands of an expert, filler is a critical part of an age-defying toolkit. Used to restore lost volume and enhance features, dermal fillers like Restylane, Juvéderm, RHA and Evolysse are far from falling out of favor. But, when filler does need revision, it takes an artistic eye and an expert hand to get the best results.

Why Does Filler Go Wrong?

“It’s not the filler, it’s the filler,” is a common saying among experts to denote that the responsibility of poorly placed filler lies with the practitioner themselves.

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Beverly Hills, CA facial plastic surgeon Kimberly Lee, MD says that when fillers are done well, they should not be noticeable. “The filler is a product and a static factor. It’s the skill of the injector that you’re really paying for.”

It takes a knowledgeable professional to realize filler has migrated or been placed improperly, and to correct it takes experience and an artistic eye.

El Paso, TX plastic surgeon Ozan Sozer, MD

“Placing dermal filler is an art form,” explains Southlake, TX dermatologist Janine Hopkins, MD. “You need a truly comprehensive understanding of facial anatomy to ensure that filler looks balanced and natural, and also ages well.”

According to Houston dermatologist Jennifer Segal, MD, increased interest in filler correction, and even reversal, has been a long time coming. “I think we’re seeing what happens when poor craftsmanship ages,” she says. “When non-experts don’t consider how fillers will look down the line, and when they don’t have enough experience injecting to account for smoothness and symmetry, it creates problems.”

DID YOU KNOW?

Usually two to four weeks after filler correction is when patients can explore other treatments to enhance skin quality or surgical solutions to address laxity.

Where Does Filler Need Revision Most?

According to Charlotte, NC plastic surgeon Gaurav Bharti, MD, common areas requiring correction or reversal include the lips, cheeks, tear trough, jawline and chin. “Patients seeking correction are often focused on issues of asymmetry, lumps and bumps, and an unnatural appearance,” adds Wichita, KS plastic surgeon Amy M. Sprole, MD.

New York facial plastic surgeon John Kang, MD says another typical cause for filler correction is the Tyndall Effect. “This is a bluish discoloration caused by the scattering of light through poorly placed hyaluronic acid filler,” he explains. “It’s particularly common in the tear trough area.”

Undoing Prior Filler

“Dissolving the previously placed filler is always a necessary step,” says Dr. Kang. “We accomplish that by injecting an enzyme called hyaluronidase that breaks down and dissolves hyaluronic acid fillers.”

But, that’s not all that goes into a correction. “It’s not a one-and-done process,” says Dr. Bharti. “Removing filler may require multiple sessions.” We also encourage a recovery period to allow the skin and soft tissues time to heal and remodel naturally.” And, Charlotte, NC plastic surgeon Bill Kortesis, MD adds that further treatment may be needed to enhance skin quality or restore volume to provide structure. “This could involve procedures that use natural tissue, such as the patient’s own fat, or biostimulator treatments like Sculptra, Restylane, Radiesse or Renuva,” Dr. Kortesis explains.

When non-hyaluronic acid fillers (like Sculptra or Bellafill) need correction, they can’t be dissolved with hyaluronidase. Patients can wait for these fillers to be absorbed by the body, but Dr. Lee notes that some cases may require more filler, not less. “When filler isn’t properly injected into the right spot, it can sometimes be manipulated into the desired location—though that can be easier said than done,” she says. “Other times, patients just need more filler to get full correction.”

Surgical Correction

Sometimes, though, surgical removal may be necessary. “Fortunately, that is not very common,” says Dr. Sprole. “I have removed lumps of filler in various places when they were either a poorly placed permanent filler or a resorbable filler that failed to resorb.”

Overfilling isn’t the only reason for surgical intervention. “Sometimes, a procedure is required to address or remove a granuloma, which is a type of inflammatory reaction that can result from filler injections,” adds Dr. Kortesis. “These situations require a more comprehensive treatment approach to treat both the infection and the patient, and address any resulting complications,” adds Dr. Lee.

More than 47 percent of NewBeauty readers report having had filler treatments in the past.

Source: BeautyEngine

Filler Correction as a Specialty?

Just like one should prioritize skill and experience when getting filler placed, filler correction should also be performed by a technical expert. “Filler correction is a complex task that requires expert knowledge,” Dr. Segal says. “Each case is unique and may require its own approach. Ultimately, I think it will become its own specialty.

In the world of aesthetics, revision cases present unique and complex challenges for providers to overcome, and this holds true when it comes to correcting filler. “It is an art form,” Dr. Lee says. “As with any revision treatment, the cards have already been dealt and we’re trying to make the best of the situation.”

“Just like how revision surgery is always more challenging, revising or correcting poorly placed filler requires a much more in-depth understanding of the anatomy and a greater artistic sense of how filler can both enhance, as well as potentially worsen, the appearance of injected area,” explains Dr. Kang.