The “Megan to Megatron” posts started from a year-old Letterboxd interview, and one of the most shared photos is tagged AI-generated by the account that posted it. No doctor is quoted (IBTimes UK). Nobody at Southwest Plastic Surgery will diagnose her from a screenshot.
What Dr. Frank Agullo checks when a MedSpa patient asks the same question about her own face, in his words.
1. Is this swelling or did my filler move?
“Normal puffiness or swelling, typical in the mornings or after a late night and heavy salt intake, is soft. We can usually make some of it disappear with cold pressure, and it dissipates during the day.”
“Filler migration requires a history of filler. You have added volume in an area close to where the filler was placed, so it has, in quotations, migrated. It is palpable; filler can be felt outside of where it was originally injected.”
2. Why is the area swelling months after the injection?
“Fillers can create a type of inflammation. It may not be constant, but the tissue around the filler itself may swell up.”
“Filler can also block lymphatic drainage and make morning swelling in the injected area even worse.”
“When patients use fillers, they see that they have to have this redone anywhere from every six months to one year. And what we’re also seeing is that not all of that filler goes away, but it’s migrating and flattening out, so it’s not giving us the volume exactly where we want it.”
3. What does overfilled actually mean?
“I think we have seen that facial fillers have been quite overdone, and patients are really getting away from looking overfilled and want to look more natural. We have seen that these hyaluronic acid fillers may not dissolve completely, and they do tend to migrate. It seems like they create some kind of inflammatory response in some patients, creating nodules or inflammation. And of course, the feel of a filler is not quite like natural fat, which is squishy and soft, something whose borders you wouldn’t be able to identify the way you can with a filler.”
“Filler cannot really give us a natural feel. When properly done it can give us a natural look, but it’s often overdone. It can also not give us a long lasting result, and this is where fat has its benefits.”
4. Why does a treated forehead sometimes look frozen?
“I myself get botulinum toxin in the forehead, crow’s feet, and glabella lines every three to four months, just to maintain the wrinkle free appearance with a dose that still lets me express my face without looking abnormal.”
“Dose, dilution, injection placement, and product choice matter more than whether you are active or inactive. These are all customized depending on each patient’s consultation. For example, patients with very strong frontalis muscles, glabellar muscles, or masseters will require a higher dose than others.”
5. What are patients choosing instead?
“In my practice, I’ve seen more than a twenty to thirty percent decrease in the use of fillers, and a shift toward biostimulators and donor fat grafts instead.”
More in fillers vs fat and tear trough filler. Dr. Agullo’s commentary is on drworldwide.com; the surgical options are on agulloplasticsurgery.com.
Why Choose Dr. Agullo
Dr. Frank Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. Every injectable treatment at The MedSpa at Southwest Plastic Surgery is performed by an experienced, licensed provider under his direction.
Ready to Talk?
Not sure whether what you see is filler, swelling or the light? Come in and let the team press on it. It takes a minute.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful
Find Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
