Approximately 80% of 'migrated filler' cases that come to me for a second opinion are not actually migration; it's the natural behavior of a high-G' product placed in the wrong tissue plane.
For the past three or four years, the phrase 'filler migrated' has become widespread on social media. As someone who has been in this field for thirty years, I can say: a large part of what we're talking about is not migration.
Hyaluronic acid fillers have different G' (hardness) values. A high G' product — for example, Voluma — is designed to be placed deep on the periosteum, over the bone. If you place the same product in the superficial dermis, it will stay there for 18 months but will always leave a swollen, 'lumpy' feeling in that area. The patient says 'it migrated'; in reality, the product went nowhere — it was placed in the wrong layer.
The pattern I observe in the overwhelming majority of filler cases that come to me for a second opinion is this: the product itself is not the problem, the tissue plane where it was placed is the problem. Those who inject a low G' product (like Volbella) deeply and then ask 'why did it disappear after a week' are making the inverse of the same mistake.
In thirty years of experience, the number of cases where I've seen true migration — meaning the product anatomically shifting from its initial placement to another area — can be counted on the fingers of one hand. Moreover, most of these developed after infection, trauma, or very aggressive massage.
I tell patients this: a product being 'correct' comes not only from its brand, but also from which layer, with which cannula, and at what angle it is placed. In consultation, one should not think 'let's put this product', but rather 'in this area, a product with this behavior is needed in this plane'.
The swollen lips and deflated cheekbones seen on social media are mostly not the result of a 'terrible product' — but the accumulated effect of the wrong plane over the years.