What Happens to Filler Years Later? Dr. Paul Nassif Says It May Not Stay Where You Think
What happens to filler years later may be more complex than expected, based on what surgeons are now seeing in the operating room.
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You got filler once. Twice. Might’ve lost count. You’ve gone to a good injector, you’re happy with the results, and you’ve largely moved on. What you probably haven’t thought about is what that filler is doing right now, years later, inside the deeper layers of your face.
Dr. Paul Nassif is a Beverly Hills–based facial plastic surgeon, founder of NassifMD® Skincare, and Botched co-star known for fixing complex revision cases. And what he’s seeing now is changing how surgeons think about the face long before surgery is even on the table.
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Can Dermal Filler Move Over Time?
On a recent episode of the ‘Live + Well’ podcast, Dr. Nassif told host Melissa Magsaysay that he is part of a group text with some of the country’s top facial plastic surgeons. “I’m on a text chain with probably a hundred of the top plastic surgeons that operate on the face,” he says. “And what we’re talking about is, let’s say you go in for some filler, sometimes now, when we’re doing a facelift, I notice the material…” And not in its intended area.
In one recent case, a patient told him she had received hyaluronic acid filler exactly once, three years earlier, in the tear trough. The hollow just beneath the eye. That was it. One treatment, one area. But as Nassif performed a deep plane facelift near the jaw, nowhere near the original injection site, he found material embedded in the tissue. “It was filler,” he says. “So it can stay sometimes longer and not go away, and it can migrate.”
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Another patient, he said, same answer. One treatment, years ago, somewhere else entirely. “It migrated from here to here,” he says. “It floated somehow through all the different tissue planes in a period of three years.”
To understand why this is possible, it helps to know what hyaluronic acid filler actually is. HA is hydrophilic. It attracts and holds water. And it sits inside soft tissue that is constantly in motion. Muscles contracting, expressions shifting, gravity doing its thing. A 2023 narrative review in the journal Cosmetics identified clinical reports of filler migration, with hyaluronic acid among the most commonly implicated substances. Whether it happens in any given patient likely depends on the product, where it was placed, and the individual anatomy. But it does happen.
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Do RF Microneedling and Skin Tightening Treatments Cause Scar Tissue?
Migration is one thing. But what Nassif describes next is something the aesthetic industry has been slower to talk about. When performing facelifts, he and colleagues have started encountering tissue that actually doesn’t behave the way it should. The dissection, the careful separation of skin from the underlying muscle structure, is harder than expected.
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And when they investigate why, they are finding scar tissue where there really shouldn’t be any. The culprit, in his observation, is often the category of treatment that markets itself as having no downtime…microneedling.
These devices work by creating controlled microtrauma… the idea being that small injuries prompt the body to produce fresh collagen. “Now we’re finding out that it does cause some scarring in the deeper tissue,” Nassif says. “As I’m lifting up the skin from the underlying musculature of the face and the tissue, we’re finding the dissection a little bit difficult. Why? We’re finding scar.”
“When we go into the deep plane, the deeper layers of the skin, where we initially thought that these treatments are only superficial, are going deep, causing deeper scarred tissue.” Scar tissue, in a surgical context, is not just an inconvenience. It obscures anatomy. It makes it harder to identify the nerves that control facial movement. It turns a lower-risk operation into a higher-stakes one. “Which makes the risk of doing that deep plane facelift a little bit more riskier,” he says.
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This tracks with what’s emerged from the broader medical literature. A review published in JMIR Dermatology in 2026 concluded that RF microneedling “may lead to dermal fibrosis, tissue adhesions, and altered superficial musculoaponeurotic system composition, which could interfere with future facelift procedures.” And the FDA issued a safety communication flagging reports of scarring, fat loss, and nerve damage from RF microneedling devices. All this to say, Nassif is careful to frame all of this as early and evolving: “I’m telling you this is what we are preliminarily seeing right now.”
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Is Dissolving Filler Safe? What to Know About Hyaluronidase and Volume Loss
So far, the cultural response to filler concerns has largely been to dissolve it. Celebrities and influencers have made a visible trend of having fillers dissolved with an enzyme called hyaluronidase, framing it as a reset. Nassif understands the appeal. He also describes something those conversations tend to leave out. “I have seen patients who have gone in for dissolving fillers, and then after they’re finished, they said… I’ve lost some of my natural volume,” he explains. “So it could have damaged some of their natural hyaluronic acid.”
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Hyaluronidase doesn’t distinguish between what was injected and what was already there. “You don’t wanna make a habit of going and having filler dissolved,” he says. Because aggressive or repeated dissolution may not simply remove the filler. It may also take some of the original tissue with it.
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Why Fat Transfer Is Gaining Popularity Over Filler
All of this has accelerated a shift Nassif has been watching for a while. Fat grafting. Harvesting fat from somewhere on the patient’s body and re-injecting it into the face. This has been around for decades. What’s changed, though, is the seriousness with which surgeons are approaching it.
“Me and a bunch of my colleagues we used to do fat grafting when we’re doing a facelift or something, maybe in 10 minutes,” he says. “Now we’re studying the face, we’re looking at all different views of the face, and when we go in the operating room, we will harvest fat.”
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The appeal is pretty straightforward, he says. It’s your own tissue. It doesn’t migrate the way filler can. It doesn’t leave behind a residue that complicates a later surgery. And when it works, it works in a way that integrates with the face rather than sitting inside it. The catch, though, is that roughly half of it doesn’t survive. “About 50%,” Nassif says, when asked for a number.
And that means the instinct to compensate, to put in more, just in case, is exactly the wrong move. The fat cells that do survive are living tissue, which means they respond to weight changes just like any other fat in the body. He’s seen what happens when surgeons from an earlier era overcorrected. “They gain weight or something happened, and they destroyed their face because the fat cells enlarged.” The right approach, as he describes it, is conservative.
Place less than you think you need. Come back and add more if necessary. Trying to remove it later is not a clean option. The tools required to extract fat from the face can damage nerves and create the exact kind of scarring you were trying to avoid.
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What This Means for Dermal Filler Over Time
Nassif’s practice does filler every day. He is not arguing against it. He’s arguing for thinking about the face as something that accumulates history. And that we’re doing at 35 or 40 is still inside our faces at 50 or 55, whether or not we can see it from the outside.
“I think throughout the next five years we’re gonna have more publications talking about the good and the bad and the ugly with having minimally invasive procedures,” he says.
That is the conversation that’s actually happening among the surgeons who see inside faces for a living. Not whether filler is good or bad, but what it does over time…and what that means for whoever picks up a scalpel later.
Listen to the full episode of Live + Well with Melissa Magsaysay on Spotify and Apple Podcasts.
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