Saint Paul Juvederm doctors

Fortunately, when things settle and the HA filler (regardless of the manufacturer, Juvederm or Restylane is not the problem here) completely reabsorbs, your "old" pre-filler lips will remain. That is, IF you stop fooling around with more Juvederm, then Wydase (hyaluronidase), then more Juvederm, then more Wydase! You have correctly determined that it is the technique (or the injector), not the product that is at fault here.

Please realize that some of the swelling immediately after HA injection may be due to blood vessels being hit (there are LOTS in the lips) and minute bruises or swellings result from this, NOT the HA filler. By your own description you were "very bruised" and this must resolve before more filler or any enzyme "HA-dissolver" is reasonable. Of course, when confronted by an upset and inconsolable patient, many injectors go for the needle and try to "even it out" with more filler, or to "dissolve the excess." More bruising and unevenness! Perhaps even enough to cause scar tissue?

Most injectors erroneously think that Hyaluronidase dissolves "excess" injected HA filler (Juvederm, Restylane, Perlane, Juvederm Ultra Plus, etc.). HA fillers are designed to mimic "natural" substances already present in our bodies; that is why no allergy testing is needed, and why these fillers are so popular.

Our bodies' natural hyaluronic acid (HA) molecules are not artificially crosslinked, whereas injectable HA fillers consist of intentionally more-crosslinked (manufactured) molecules to provide increased longevity and durability, so the improvement lasts as long as possible. Since hyaluronidase is an enzyme that breaks down HA, it will break down our natural HA much more rapidly and thoroughly than injected, crosslinked, and more resistant-to-breakdown HA fillers. So your doctor is not really breaking down the excess injected HA as much as thinning the background natural HA bulk you possess. So this is not exactly a one-for-one effect, and the result can be variable and irregular. More enzyme in a few days is usually not the answer here.

In other words, it pays to be more careful initially, and inject the HA filler precisely, conservatively, and evenly--you can always add more in a few days or weeks, when any bruising or swelling from the needle sticks resolves and reveals the true result. Then, additional touch-up filler can be judiciously added, rather than your unfortunate scenario: pay for HA, have (some) enzyme injection to decrease the bulk (?cost for the hyaluronidase), and still more HA filler to "touch-up," followed by even more Wydase!

A bit at a time is also more cost-effective than the blob and reduce method.

Stop everything for 6-9 months, then seek an injector who views HA fillers as precision art rather than "spackle filling."

Using a filler, like Juvederm, can be highly gratifying to enhance the appearance of your lips.  Looking at your pictures, I would agree with your ideas as to where enhancement would make the biggest difference.

A word of caution; you have the type of lips that I approach with the most caution.  Very volume depleted lips always look better with filler injection, almost irregardless of technique.  Lips, like yours, that start out looking nice are quite easy to make appear fake.  I know because as a plastic surgeon, patients routinely come to me to fix their lips after having had injections at a salon or spa.

Finally, avoid anyone that uses a standard technique.  I always discuss the look that we are trying to achieve and adjust my technique accordingly.  How can you tell?  At your initial consultation, the physician will examine your lips, explain what they are seeing and then ask what you want.  If they look at your lips and say: "you need 1 syringe" without addressing your aesthetic goals, then thank them, say you have to think about it and find another physician.

Juvederm is a filler that can be used to treat irregularities of the skin contour that can be improved by adding volume. If your scar is depressed, than Juvederm may be helpful.  It will not improve the appearance of raised scars or widened scars.