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Always go back to the doctor who did the treatment. If at that time you don't feel satisfied, and the doctor has looked at you---did not just talk to you on the phone-- then I would recommend getting a second opinion. You want a board certified dermatologist ( at least this is what is recommended in the United States, or plastic surgeon. The greatest advantage of Voluma is that it can be reversed with hyaluronidase (an injectable) which any experienced physician will have on hand.
Hope this helps you!
I tell my patients that it will take a full 10 days to 2 weeks for the tenderness and swelling to subside after Juvederm injection, and for your final results to be apparent. Tenderness at 3 days after injection is quite normal, as is the "firmness" that you're feeling. Firmness can be felt with all hyaluronic acid products (Juvederm, Restylane, and Perlane) initially, and Juvederm Voluma is the thickest of these products, so firmness at this stage is expected. I agree- don't massage, just wait it out. Incidentally, I also use Juvederm Voluma in the temples- to fill temporal hollowing. With Voluma injection to the temple, an expected side effect is some initial tenderness when you chew.
Juvederm Voluma is a much thicker and more robust filler than other hyaluronic filler products which is why it is so effective for deflated cheeks and mid face rejuvenation. It is not uncommon for the cheeks to feel swollen after treatment and even a hardness in the treated area. The healing can take a few days to a week, so it is not uncommon to have swelling 3 day post-op. The side effects to look out at this point in time would be worsening swelling and redness, worsening tenderness, fever or any other signs of an infection. If your symptoms are getting worse, it is advisable to call your physician and have them evaluate the treated area.
Juvederm Voluma is an excellent volumizing filler for the cheek area
and it will soften gradually over time.
Voluma is a great product for lifting deflated cheeks. It gives lift because it is quite viscous. The great news is that cheek correction can last for 2-3 years in certain cases. The product can feel stiff under the skin for up to a week or more, and some tenderness is not uncommon - lasting from a few days to a week. If you are experiencing an increase in pain, associated with tenderness, redness or swelling, then you may have an infection and should contact your doctor.
Unlike other fillers, Juvederm has the unique ability to lift the overlying cheek when injected because of its special mechanical properties. This coupled with a little swelling around the injection points can create a sensation of temporary bumpiness which is not visible but often felt. This usually subsides by two weeks but can last up to 4 weeks. Once the minor swelling subsides you will not be able to feel the product. Other than icing and refraining from vigorous exercise for 24 hours no special precautions are needed. Some physicians will prescribe arnica. Do not massage the areas as this will lead to more swelling.
Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York
Board Certified Facial Plastic Surgeon
Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for:
Allergan (Juvederm, Voluma), Valient (Scultpra,
Cynosure (Cellulaze, Precision Laser Lift)
& Solta (Fraxel, Thermage)
Most likely you have a mild bruise overlying the cheekbone where the voluma was injected. Voluma is a more viscous product than other fillers and to provide adequate volume and lifting, it has to be put deeper into the facial skin and tissues. Treating this with head elevation, cool compresses, and limiting heavy activity until this subsides should help.
We use blunt cannulas in our practice and this decreases bruising to less than 95% though we still see bruising occasionally.
We are seeing occasional bruising and minimal swelling. Patients do report firmness early on compared to other fillers but this tends to subside within the first week or so.
Most deeper plane injections can cause some brief swelling and firmness of the soft tissues of the cheek, and Voluma is a firmer filler than most, so it can cause slightly more that we are used to seeing. Having said that, it can also be distributed irregularly or inaccurately, and this can cause firm lumps, asymmetry, and irregularity. Because these can be a normal thing early on, say in the first few days to a week and we don't have a good way of always telling the difference, I suggest that people be patient, use some ice to control any swelling, gently massage the areas of firmness or irregularity to promote both the resolution of swelling as well as the even distribution of the filler in the tissues (in contrast to your dermatologist), and if there is no improvement by a week, then follow up evaluation is indicated. If the product was injected using a needle instead of a cannula, especially in the lateral cheek where there are a number of larger blood vessels, these could be punctured causing some bleeding into the tissues with resultant firmness, swelling, and irregularity. While not a long term problem, this will cause the findings that you are seeing in the short term, and in some instances may take up to a few weeks to resolve. There is no evidence that arnica lessens any of the effects of this, although it is quite frequently recommended and used, and it is certainly safe for most people if used as directed. The main thing is to allow enough time for resolution of any swelling or short term tissues changes, and if that doesn't correct it, the filler should be adjusted.
Asymmetrical hardness and tenderness three days after Voluma injections may indicate a deep hematoma (collection of blood) that may manifest as a delayed bruise. Voluma is injected deep under the facial muscles just over bone. The size of the swelling should resolve as the hematoma resolves. We usually recommend cold compresses for the first 48 hours after Voluma injections if there is any bruising. After 48 for bruises we then recommend warm compresses. It is best to have your injecting physician evaluate you for any concerns that you may have. Good luck and be well.