Why does Juvederm leave a bump after the injections?

Sometimes the skin reacts to the needle injection. This usually goes away in a few hours after injection.  Sometimes the Juvederm is injected too close to the skin and becomes palpable.  I usually mold the Juvederm with my fingers to flatten out any irregularities.  I also tell my patients that they can do the same over the first few days if they feel it is a bit lumpy.

In order to properly answer your question, we first need to talk about the various kinds of lumps that can occur after a treatment with dermal fillers.  Keep in mind that Juvederm, as well as the other fillers, are all surgical implants. 

Although we are inserting these implants with a needle, they are still considered a form of a surgical implant.  It would not be unreasonable for you to be able to feel a lump in the area of the injection. Any lump that you do feel should be smooth and tapered.

Some of the fillers such as a Juvederm Ultra Plus are thicker than other fillers. The more filler that is injected the more likely you are going to be able to feel the material after the injection.  Feeling the material after the injection is fairly common.  However, you should not be able to see any lump if the injection is done properly.  The injector will generally massage the material during and after the injection to ensure the absence of any visible lumps.

Because we are using a needle to place the material into the soft tissue it is highly likely that some bruises will form.  These bruises can cause small lumps which should resolve on their own with no treatment.

If there is some scar tissue within the soft tissue that it is being injected, the injection of the material may raise the scar tissue towards the surface of the skin where it will cause a visible or palpable lump.

If the injector applies too much pressure to the barrel of a syringe while he is withdrawing the needle, he may leave some material in the needle track as he is pulling the needle out of the soft tissue.  This will place a small amount of material close to the surface of the skin where you may see and feel a tiny lump.  If this happens during the injection and the injector sees it, it is fairly easy to squeeze the soft tissue and express the material from the needle track to prevent this kind of lump.

If the material forms a lump after your procedure and it solidifies your doctor can inject the lump with a chemical called hyaluronidase that will dissolve a lump.

Although it is technically possible to become allergic to Juvederm it is highly unlikely.  As far as I know there has only been one case report of a true allergic reaction to Juvederm.  The potential for an allergic reaction occurs because the Juvederm is cross-linked which makes this form of hyaluronic acid slightly different than the hyaluronic acid that is normally found in your skin. If this were to happen the lump could be treated with a small amount of injectable steroid.

There can be a few reasons that Juvederm is leaving a “bump” in the same place:

Injecting too close to the surface. If this occurs, Juvederm can cause a raised area underneath the skin. Seek treatment from a medical doctor experienced in Juvederm injections to reduce the likelihood of this happening. Often, these superficial “bumps” can be massaged out during a follow-up appointment.

Many doctors will not only inject at a proper depth, but also “mold” or “massage” the injected area during treatment to minimize a “bumpy” feel. I do this in my office, and patients are very satisfied with the subsequent results.

Previous scars and injuries in a treatment area can cause Juvederm to keep “lumping” in the same area with repeated treatments. This can be due to previous injuries, permanent soft tissue augmentation (such as fat injections), or plastic surgery in a treatment area.

I always perform a complete medical history prior to injecting Juvederm and other fillers in order to know about previous injuries or surgeries. If the anatomy has been changed by scars or operations, a knowledgeable doctor will be able to tell you what can and can’t be done in this area, as well as potential complications.

Inflammation at the injection site. Some patients may have inflammation at the area where the Juvederm needle was injected. I have not seen this occur, but injection site reactions are always possible. Normally, these reactions improve within several days. For mild inflammation, a 1% hydrocortisone cream applied twice daily for 3 days can be useful.

Too much Juvederm in the treatment area. An experienced doctor usually doesn’t see this complication. If there is just too much Juvederm in a treatment area, an enzyme called hyaluronidase can be injected to break down the Juvederm. Proper injection technique usually makes correction with hyaluronidase unnecessary.

When dermal fillers are injected the material expands the surrounding tissue. This is normal, and may cause some raising of the skin surface.

Over a few days this subsides to a flatter surface, while maintaining the cosmetic improvements for the life of the filler. The duration of the filling effect will vary with the type, location, and volume of filler used.

Technique is critical when injecting fillers.  The injection of the product should stop about 1 mm before the needle is removed, otherwise product will be injected too superficially as the needle is withdrawn, creating those little bumps. 

Any bumps that are present during the injection session should be massaged out before you leave. Fortunately, over the first day or two, the product absorbs some water from under the skin, and the bumps resolve.  

Remember, it's the filler, not the filler.  Good luck with your next treatment.

Injecting filling agents such as Juvederm or Restylane is very much technique- and physician-dependent. In other words, the doctor must know what he or she is doing, and many do not.

When you inject Juvederm, if it is too deep, it is absorbed by underlying tissues and does not specifically fill the wrinkle. But if you inject too superficially or too close to the surface, you can end up with lumps. Generally, these will go away within a week, but for persistent lumps, you may need to undergo additional injections with an enzyme named hyaluronidase to dissolve the filler material.

Choose your injecting doctor carefully. Make sure he or she is board certified in dermatology, plastic and reconstructive surgery, head and neck surgery or oculoplastic surgery.

The bump may be from the Juvederm itself, or it may be from inflammation at the injection site.

Fillers are injected into the dermis of the skin, not in the very top layers of the skin. If the injector keeps pushing the material into your skin as he or she is pulling out the needle, there might be some product injected too high in the skin. This would cause a little bump that you can feel, or even see.  Most bumps are easily smoothed out with some pressure and massage.

Sometimes the act of getting an injection can cause some inflammation in the skin. The pinpoint area can get red or pink and a little swollen. Apply a cold compress and maybe even a mild cortisone cream.