The Filler Fix: How Center Can Amend Previous Injections Missteps

The goal of any treatment at Center Aesthetic & Dermatology is a healthy, natural, youthful look. In this case, this patient came to us looking to improve her overall appearance.  She has had previous injectable treatments in other states, most recently 3 weeks ago.  She reports she has her cheeks and lips injected regularly as well as Botox in her upper face.  After evaluating her, the previous work may have created a more aged look as opposed to a more youthful look.  When this scenario occurs, we must decide to dissolve and refill or work around the other work to camouflage or blend.  Dissolving would have been the appropriate next step, but this patient was visiting from out of town.  There would not be enough time to dissolve and refill.  Below is an explanation of the steps taken to improve her overall appearance.

Note the Dotted Areas as Points of Treatment: 

The Botox in her frontalis/glabella is at full effect and the areas are immobile, while the peaks of the brows are very mobile, giving the patient a “spike brow” appearance.  This is marked by the purple dots on the patient’s R brow.  To combat this muscular action, 2 units of Botox will be used on the R side and 1 unit of Botox on the L side to weaken this muscle.

The patient reports her primary concern in the past was her NL folds and lower face and she has had multiple cheek injections to lift the area.  Filling the cheeks without addressing the transitional space between the tear trough and the cheek cause two problems.  First, the ridge of cheek filler is unnatural looking.  Second, the ridge and excess volume in the cheeks gives the tear troughs a hollowed look.  The grey markers demonstrate the ridge or “step-off” in this area of transition and the red markers denote the inferior border of the filler.  To address both issues without the option of dissolving and refilling, filler was used to smooth the transitional space.  With an unlimited budget, another 1-2 syringes could smooth this transition even more

The patient also is unhappy with the shape/size of her lips and would like more filler here.  Demonstrated by the blue markers, the previous filler is mostly outside of the vermillion border.  This could be deliberate if the goal was filling any fine lines above or below the lip, but in this case, it is more likely that a soft filler was used and subsequently migrated outside of the borders and now makes the lips look unnatural and turned under.  To combat this appearance, we will use a stiffer product (less likely to migrate) in the belly of the lip and attempt to camouflage the filler outside of the vermillion.  This will make her shape appear more natural. 

The patient’s primary concern today is the NL folds, lower face “sagging,” and pre-jowls.  The patient is not sure if she has had filler here recently.  Today, we will address the NL folds by first placing filler in the piriform/precanine fossa, followed by linear injections both parallel and perpendicular to the NL fold.  The marionette lines will be treated in a similar manor, with linear injections into the area of concern. 

There are two ways to address the jawline/pre-jowls.  Filler could be injected at the angle of the mandible to lift and extend the jawline posteriorly with the goal of lifting/tightening the skin causing the appearance of jowls.  Alternatively, filler can be placed in the pre-jowl sulcus to soften the appearance of the jowl and straighten the jawline.  With unlimited filler/budget, the appropriate approach in this case would be to extend the jawline posteriorly at the angle of the mandible and likely 2-4 syringes would be necessary.  Today, we will use what filler is left after NL fold and marionette line correction to camouflage the appearance of jowls. 

Our Patient left feeling completely refreshed and more beautiful than ever. We were able to educate her on the treatments she's received previously, and what elements and technique of dermal fillers affect her facial structure and how. We always recommend our patients to join us for a complimentary consultation where we can educate them on any question, big or small, to feel comfortable before receiving treatment. It's your face! Treat it well! Please reach out to us at with any inquiries. We are always here for you.

Pictured Below - Before & After:

Addressing the "Ridge" under the eye, caused by excess in cheek filler. The lower picture shows how Lauren was able to soften this ridge using Restylane & Vollure Filler. 

Lauren Mitschrich PA-C Lauren is Center's Board Certified Physician Assistant and specializes in Cosmetic, Medical, and Surgical Dermatology. Her passion for all things aesthetic and "natural look" approach make her a unique perspective for our patients. She brings her love of aesthetics and dermatology to Center, practicing at the intersection of art & science with her patients - she understands the physiology of your skin, the building blocks of your beauty, and the trust you put in her to help you become the best version of you, ever.

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