Filler Sagging Side Effect: What Happens When Filler Is Placed in the Wrong Area

Filler Sagging Side Effect: What Happens When Filler Is Placed in the Wrong Area

Before You Read — Check This First

Q. Doesn't more Filler mean firmer, bouncier skin?

A. Actually, it's the opposite.

When Filler is injected in excess

into the outer cheekbone area or the center of the cheeks,

it becomes dead weight

and causes the tissue to sag downward with gravity.

Q. Why is "sagging" rarely talked about as a Filler side effect?

A. Unlike Bruise or Swelling that resolves within days,

sagging reveals itself gradually over several months.

Many patients are satisfied right after the procedure,

only to notice the change in the mirror 3–6 months later.

Filler Side Effects — Let Me Give You an Honest Breakdown

Filler side effects is a broad term

that refers to any unintended reaction following a procedure.

Unlike the commonly imagined Bruise or Swelling,

sagging, nodules, and vascular occlusion

often don't appear right after the procedure —

they tend to surface over time.

Broadly speaking, they fall into four categories:

immediate reactions (Bruise, Swelling, Pain),

mid-term reactions (nodules, distortion, migration),

mid-to-long-term reactions (sagging, volume loss),

and emergency situations (vascular occlusion).

Filler Sagging Is Not About Volume — It's About Injection Depth

If you searched "filler sagging side effect" and landed on this post,

you're probably one of two types of readers.

One is someone who hasn't had the procedure yet and is worried in advance.

The other is someone who already had it done

and keeps noticing sagging every time they look in the mirror,

trying to figure out why.

Both of you actually need the same answer:

"Why does Filler sometimes make things look more saggy, not less?"

Let me get straight to the point —

with Filler, the placement location and injection depth

determine about 80% of the outcome.

Even with the same 1cc,

if it's placed in the subcutaneous layer on the outer cheekbone, it creates sagging weight,

whereas if it's placed in the deep layer near the bone (the MD Code point),

it acts as a lifting force.

Anatomically speaking,

the face is structured so that the skin and fat above the SMAS Layer

are suspended by retaining ligaments.

When Filler is placed in the deep layer near these ligament attachment points,

it reinforces the support structure and creates an upward pull.

On the other hand, when volume accumulates

in the outer subcutaneous fat layer — far from those ligaments —

the increased weight of the suspended tissue

causes it to sag downward with gravity.

This type of case comes up so often that I want to document it specifically.

Last month, a 34-year-old patient came in

who had received 2cc on each side of the cheekbones

at another clinic six months prior.

She was satisfied at first,

but by the third month she described a heavy feeling in her cheeks,

and by months four to five, she said her Nasolabial Folds

had actually deepened.

On ultrasound,

the Filler was found to have spread widely

in the subcutaneous layer lateral to the zygomatic bone.

It had become suspended weight rather than a support point.

We partially dissolved it with hyaluronidase,

then re-injected just 0.4cc into the periosteal layer

near the zygomatic arch.

The facial contour was restored within two weeks.

She said, "I had no idea it could come back this quickly" —

it was a faster recovery than anyone had anticipated.

But there's something even more serious than sagging —

and that's vascular occlusion.

This occurs when Filler enters an artery directly

or compresses a vessel so severely

that blood flow becomes blocked.

The incidence is low (reported at around 0.05–0.1%),

but when it happens, every minute counts.

Early warning signs include abnormal blanching on one side

immediately to within hours after the procedure,

a mottled reticular pattern appearing

even in areas away from the injection site,

and in some cases, progressively worsening Pain.

From that point, administering a high-dose hyaluronidase injection

within six hours to dissolve the blockage

is the critical step in preventing tissue necrosis.

Vascular Occlusion Emergency Response and Sagging Recovery Timeline

Find your case in the table below.

Looking at the recovery timeline through actual cases makes it much clearer.

Last week, a 42-year-old patient came in.

During the procedure, one side of her nostril area

suddenly turned white.

The reticular pattern was immediately visible — a classic early occlusion sign.

I stopped the procedure immediately

and administered 750 IU of hyaluronidase in divided injections.

Warm compress, massage, and aspirin were used in combination,

and color returned within two hours.

I monitored for 72 hours

to confirm there were no signs of re-occlusion.

She said, "I didn't think it could be resolved this quickly" —

and the reason it was possible

was that it was caught immediately during the procedure.

If she had gone home and discovered it six hours later,

tissue necrosis may have already begun.

That's why for the first 24 hours after the procedure,

please check your mirror frequently.

Is the skin color consistent? Is Pain intensifying on just one side?

Is a new mottled pattern appearing?

Monitoring just these three things

will catch most cases early.

Filler Side Effects — 3 Questions from the Clinic

Q1. Does Filler always cause sagging? Is it better to avoid it altogether?

A. To give you the bottom line —

no, not "always."

Sagging is a consequence of volume being deposited in the wrong place,

not an inherent property of Filler itself.

In practice, sagging tends to concentrate in cases where

2cc or more is injected at once into the lateral cheekbone or center of the cheek.

In my practice, I rarely exceed 1cc in a single area.

Distributing 0.3–0.5cc increments into the deep periosteal layer

produces results that last 1–2 years without sagging.

The answer isn't to avoid the procedure —

it's to scrutinize the volume and the layer.

Along similar lines, here's another question I hear often.

Q2. So how common are side effects, really?

A. The statistics give a clear answer here.

Bruise and Swelling occur in nearly 100% of cases.

Nodules are reported in 1–5%.

Vascular occlusion is reported at 0.05–0.1%.

Sagging is harder to capture statistically,

but based on patient self-reported awareness at 3–6 months,

roughly two to three in ten patients notice it.

Particularly in the cheekbone and cheek area.

In my clinic,

I see two or three patients a month

who come in saying, "I had it done elsewhere and now I'm sagging."

That's roughly one patient per week.

It's not a rare side effect by any means.

What makes the difference is the practitioner's depth of anatomical understanding.

Before I wrap up, this next part is genuinely important.

Q3. If Filler has already caused sagging, will dissolving it restore things to normal?

A. This came up in my clinic just this morning —

a 34-year-old patient came in with cheekbone sagging,

following a very similar pattern to the case I described earlier in this post.

Yes, it can be dissolved.

One to two sessions of hyaluronidase

will eliminate most of the volume.

However, the stretched skin does not return 100% to its original state.

Tissue that has been pulled downward by weight for six months or more

will have slightly stretched ligaments,

so a subtle residual sagging may remain even after dissolution.

That's why in my approach, 4–6 weeks after dissolution,

I redistribute a small amount into the deep layer,

and if needed, pair it with Radiofrequency (RF) for SMAS tightening.

With this approach, roughly seven in ten patients

return to a contour they're satisfied with.

In favorable cases, improvement begins early.

If there's one thing to take away from today — Filler sagging is not a volume problem; it's a problem of which "layer" the Filler was placed in. The same 1cc can look entirely different in the mirror six months later depending on exactly where it was placed.


In my next post, I'll walk through what happens six months later when the same 1cc is placed in the outer cheekbone versus the MD Code point — using a simulated case where I varied the injection depth on opposite sides of the same patient's face. This has been Dr. Wi Young-jin.