Juvederm "migrating" to cheeks and other areas

I had previously been injected (by a doctor) with Restylane in my nasolabial folds (1 cc total), with success. Zero bruising or swelling and great coverage of the sunken area. When I made an appointment with the doctor again, I was greeted by a physician assistant who proceeded to sell the benefits of Juvederm Ultra Plus (less painful, more long-lasting) and suggested 2 ccs.  The injection was extremely painful, as she was applying it in a "fan shape", supposedly more effective at filling the nasolabial folds.  Bruising and swelling was extensive, lasting almost 10 days. After swelling subsided, I noticed that, besides the fact that the folds are still very noticeable, the cheeks in the area by the folds are fuller, giving me a tired, sagging look, as if the fat in my cheekbones had been dragged down towards my nose, and instead of rejuvenated I look positively haggard.  Additionally, one of the sides of my mouth has been pushed down, giving my mouth an asymmetric look.  My question are as follows:

Is it possible that the Juvederm "migrated" to the cheek sides, giving me the "pulled down" look?

Could it be that the 2 cc's were excessive, and the excess pushed my lip down?

When can I expect the Juvederm Ultra Plus to be reabsorbed completely?  Can something be done to reverse this?

Should the injection have been performed by a licensed physician, instead of an assistant?

Questions, questions....

Thank you for your consideration

[Howard Rosenberg, MD]

The Juvederm did not and does not migrate.  Its current placement was done at the time of its admininstration, but was hidden by your swelling and bruising.  It will completely disappear over time (usually about four months).  I doubt if anything could or should be done about your current situation.  Since you were happy with the technique and results of the doctor's administration of Restylane, insist that he/she do the injections in the future.  Also, I would suggest that you see that supervising physician now to demonstrate and document the results of your most recent Juvederm experience.  Injectables are often performed by nurses and physician assistants, most of whom are quite competent.