Why does Juvederm leave a bump after the injections?

Properly applied, Juvederm is the best hylauronic acid filler on the market. It is smooth, moldable after injection and the quality of syringe and needle in the package are amazing. I hated the dull needles and hard to manage syringe that came with Restylane, and the restylane molecule is so much larger that smooth results were twice as hard to achieve. If you have bumps after treatment, the injections were probably too superficial. Ask your doctor to even them out, and if it happens twice...

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.

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.    

All fillers are intended to stay in a concentrated form under your area of concern to provide the added volume. Some fillers are thicker and are placed deeper, some thinner, and are placed more superficial. In either case, a skilled hand should be able to palpate the material. But in no case should a bump be visible. There is a easy solution to your problem. Both you and your doctor should look into the mirror together to identify any irregularities. Proper massage immediately after the injection can always smooth out the visible bumps.

After Juvederm injections I ended up with literal "sausages" under my eyes. Thee is a medical term for that condition (when Juvederm is injected too superficially) Thank you.