San Antonio Dermatologists

5 Months After Injection, Still Have Lump from Nasolabial Fold Injection. Could It Be a Granuloma

5 months ago I had Juvederm for naso folds. I wasn't very happy with results, 1 side didn't need as much but I feel he overfilled. When he was injecting that side, on the last injection he pulled out the needle & right away there was a lump at injection site along with more bleeding than any other area. He said it will go down. 10 days later still there, went back in. Dr did nothing. Now 5 mos later, Juve is slightly going away & lump seems more noticeable. How can I tell if it's a granuloma?

Juvéderm will create smooth results when injected with good technique by an experienced physician. If you have a problem and your physician isn't helping you, seek another opinion from the most experienced physician in your area who does lots of Juvéderm and other facial fillers.

A granuloma is a very specific type of reaction, and it's not likely with Juvéderm. Most likely some of the Juvéderm was deposited too superficially and it tends to disappear more slowly there than when it's deposited in the correct location. Less likely is that bleeding in the tissue could have created the lump.

The good news is that you don't have to suffer with a poor result. Hyaluronidase can be injected and completely get rid of the poorly placed product. Find an experienced physician with whom you can have a mutually beneficial relationship who can help you start over. 

Kimberly Finder, MD

San Antonio Dermatologic Surgeon

Is Needing Touch-up of Liposuction a Likely Thing?

I am scheduled for flank & thigh lipo in a few weeks. I was reading another Q&A on here and an answer from a doctor read, "it's not very often a patient needs a touch-up surgery for lipo unless under gen. anesthesia, then they usually need at least 1 or more touch-ups". I was never informed of this. I know there is always a chance for problems etc, but the use of the word "usually" sounds like I should fully expect another surgery and will spend more money... thoughts??

I think most surgeons strive to remove just the right amount of fat during liposuction and to do so as smoothly and evenly as possible, but it's not alway possible to hit the mark exactly each time for a variety of reasons. Each surgeon knows how often a touch-up is done for his/her patients. It's important to ask before you commit to surgery just how often that surgeon finds it necessary to do a touch-up. An experienced surgeon may have a touch-up rate of 1% to 3%, while a novice surgeon may have a rate of 10%. Don't be shy to ask and discuss this ahead of time.

Although the ideal is to get it exactly right the first time, it's better to under- suction than over-suction. Under-suctioning can be improved by doing a small touch-up, but over-suctioning is very hard to deal with. Have more than one consultation, and remember that experience with liposuction, or any procedure, does make a difference.

Kimberly Finder, MD

San Antonio Dermatologic Surgeon

Limitations of Juvederm in Nasolabial Folds? What Can I Expect?

I recently consulted with a plastic surgeon about juvederm for my nasolabial folds. He said that the juvederm is not injected all the way to the corners of the mouth; rather it should stop about halfway down the fold from the nose to avoid any issues with smile irregularities. This concerns me because it would not erase the pronounced line on the left side of my mouth. Is this true?

The short answer: filler can be injected to the corners of the mouth by someone who is experienced with the right technique.

But, the choice of filler and the way it is placed in the nasolabial folds depends on each person's unique problem. The best way to figure that out is to have a consultation with an experienced physician who uses all the available fillers and Sculptra (an injectable that stimulates collagen production). 

Many surgeons don't spend very much time perfecting filler injection expertise if they spend most of their time operating. Seek another face-to-face consultation with a physician who spends a lot of their time injecting fillers. I believe that only an experienced physician who regularly injects fillers has the needed expertise in understanding facial anatomy to do the best job.

Kimberly Finder, MD

San Antonio Dermatologic Surgeon