Ask a doctor

After Juvaderm Voluma in my Cheekbones, Swollen and Uneven Face

48hours later im starting to freak out still swollen in my left side but i can still easily see she misplaced the product plus giving my left side much more looks deformed as it is placed over my cheekbone leaving an unatural gap to the temples ..i will wait another 24hours but then should i correct the right with more product? or dissolve only my left side and do it again? My doctor said it was because i had damaged tissue ..but i think it was her first time with voluma.

Doctor Answers 13

Uneven results after Voluma can be due to a few different reasons

Uneven result in the first 2 to 4 weeks after Voluma maybe due to swelling which can persist up to 4 weeks due to the robust nature of this product.  Having it dissolved after a few days would be premature as would be injecting more Voluma in the opposite cheek.  Its best to wait for the swelling to subside.

Uneven results after 4 weeks is often due to physicians not being aware of pre existing facial asymmetries.  Treating both sides of the face equally in these situations will only further accentuate these asymmetries.  I find that taking good pre treatment photos, having them up during the treatment so that I can refer back to them as needed is very helpful as once swelling sets in it can be difficult to make the proper judgment as to where product is needed.  I like to use Vectra 3D photography. 

Other delayed causes can be due to an inexperienced injector placing too much product in one cheek.  In this situation, Wydase can be used to melt the Voluma but this may result in total loss of the results and having to start over. 

You made a good point about possibly needing to fill your temples to balance out the cheeks.  The temples are often hollowed out making us look older.  Filling only the cheeks will make the cheek volume look overfilled as there is not balance between the temples and cheeks.  Filling the temples at the same time will restore smooth facial curves and natural contours. 

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, Restylane),
Cynosure (Cellulaze, Precision Laser Lift) & Solta (Fraxel, Thermage)

Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 143 reviews

Voluma injections require an artistic eye.

Placing Voluma under the skin is like sculpting, you need a good eye for symmetry and balance.  One of the best things about Voluma is that the correction is immediately visible and very true to the final result. Small amounts should be injected slowly with molding to give a natural result.  Depending on the end result desired you may need more in some spots and less in others for an aesthetically pleasing result.  If your injector is new to the product you might want a more experienced second opinion.  Keep in mind you may be one of the few who gets swelling for the first few weeks, you may want to wait as long as 4 weeks to be sure that temporary swelling is not the real problem.  Good news:  it is all fixable!

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.5 out of 5 stars 18 reviews

Uneven and Bumpy: Will my Juvederm Voluma Improve 48 hours following the injections?

48 hours is too soon to evaluate your injections with this or any product. There is usually some asymmetry and lumpiness for a few days, and I wouldn't try to correct it for about a month. Reversibility is a definite advantage with any of the hyaluronic acid products, but give it time before you try to get this done.

Juvederm Voluma is an excellent product for building deficient cheeks and mid-face areas and should ultimately be smooth. I prefer to take care not to over-inject during the first session. You can always come back for another session in a month or so if necxessary.

Juvederm Voluma is Excellent for Cheek, Mid-Face & Chin Augmentation, and the nonsurgical Ten Minute Necklift

Although Juvederma Voluma is not yet available in the United States in my Upper East Side N.Y. practice, I have a great deal of experience with it in my private clinic in Israel where it has been available for the past couple of years. Unfortunately, as with so many products that have received prior approvals for use in humans by their FDA equivalents in Canada, Mexico, Europe and Israel, Voluma will very likely (hopefully) receive its FDA approval for use in the States within the next year.

Voluma is an excellent product, more robust than the current volumizing fillers, such as Perlane L or Juvederm Ultra XC, and has the advantage over Radiesse in that it can be dissolved, as can all other hyaluronic acid-based injectables, by hyaluronidase. It is excellent for areas that require real volumization, such as the cheekbone area, the mid-cheek, jawline and chin. I also prefer it over all others for my nonsurgical neck rejuvenation, the Ten Minute Necklift.

Swelling and distortion of the treated areas is very common with all hyaluronic acid products, but particularly so with Voluma. What I explain to my patients immediately after treatment (before the swelling and the bruising take full effect--which can happen in the next day or so) is that "what you see right now in the mirror is what you get again when all the dust settles," i.e. when all the swelling, bruising and redness completely resolve. I make sure to alert all patients that swelling can be uneven, so that one side can swell far more than the other, but that such distortions will resolve spontaneously in a few days. I absolutely do not retreat before three or four weeks have elapsed to be sure that no asymmetry is due to persistent tissue swelling that has been slow to resolve. And I certainly would not even consider dissolving any of the material prior to that time, as well, although, to date, I have never as yet needed to use hyaluronidase for Voluma.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 16 reviews

Don't Freak Out -- Ask Questions!!

The first rule in any situation where you are fearful is to respond, not react.
Asking the right question might get you the response that will make you realize that a problem is not so severe, is fixable, or just happens to be within the range of normal.

Having said that, the first place to start is with your doctor.  Express how you feel.  You can even ask if it was their first time, but that doesn't mean that is the problem.  My first patients did exceedingly well.

If you feel unsure or uncomfortable with the responses, get another opinion (or two) until you are comfortable with what is happening.

Whatever you do, don't rush into "fixing" what might not be a problem.
In other words, don't bleed until you're cut...LOL

There is some swelling with Voluma and sometimes it does get misplaced, even at times by patients "playing with it"

Get the facts before you act or react.
Start with your own doctor.
Move on if you feel the need.

Michael A. Greenberg, MD
Elk Grove Village Dermatologist
5.0 out of 5 stars 4 reviews

Voluma and Side Effects

Voluma is a great injection but results like all facial injections are dependent on the injector. If it looks uneven I would definitely return to your treating physician. If you feel that the physician is inexperienced please consult a board certified dermatologist. Voluma can be dissolved with hyaluronidase so try not to worry and have the situation corrected. 

Swelling with Voluma

In my experience, it is best to inject smaller aliquots of Voluma than other HA fillers because since it is more cross-linked, it is more firm than the other HA fillers, even if it means more injection sites.  I do see some subtle swelling in patients over the first few days, so if one is injecting smaller amounts most likely this will not be problematic for the patient.

It is unfortunate that you are noticing this swelling, but I do think you will be happier in the long run if you can put up with it for a few more days, so that you will be able to take advantage if its ability to provide long-lasting correction.  If your temples are hollowed out, you should consider having Radiesse, Sculptra, Juvederm Ultra plus, or Restylane to this area.  It js possible that Voluma will be used soon in the temples as well, but as of May 2014 physicians in the USA have not had enough experience in this area to recommend it, and the manufacturer has not studied this area.

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 4 reviews


The short answer is that it is way too early to intervene.  Gentle massage and icing of lumps is the approach at this point.  I would follow up with the treating doctor or another experienced injector.  Voluma is composed of hyaluronic acid which is easily reversible if needed.  

Juvederm Voluma has been distributed to a limited number of only the most experienced injectors.  You must choose a doctor very carefully because Voluma treatments require a keen aesthetic eye and advanced technique.

Good luck!

Jeffrey B. Wise, MD, FACS
Wayne Facial Plastic Surgeon
5.0 out of 5 stars 87 reviews

Uneven Face After Voluma Injections, Not Due to Voluma, Rather Due to Lack of Experience

Hi Ceptura,

As with any aesthetic treatment it is essential to choose your injecting physician most carefully, one with skill and experience.  As a trained Master Voluma injector, we have been trained to place Voluma in the proper places for natural beautiful results in our patients.  Patients having facial volume replacement should trust their face to physicians who perform an in depth facial analysis, followed by a plan for revolumization, and then skillful placement of Voluma with an artistic vision.  Without artistic vision, there can be technical success, yet aesthetic failure…which seems to have occurred to you.  Without seeing you, it is difficult to say whether your best course at this time is to dissolve the Voluma that is in excess, or add more filler to bring your face back to symmetry.  Usually we prefer to maintain volume in the face.  It is best to wait for at least 7 to 14 days for all swelling and bruising to resolve prior to further treatment.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Please wait before doing further treatments

As of Dec 12, 2013, Voluma is now approved in the USA (why do we always have to be later than almost every other country in the world??).

you definitely should wait 3-4 weeks more, at least, before considering either adding more or taking some away. it is not unusual to have uneven swelling in the first few days.

be more patient and it may turn out better than you expect.

david berman md

plastic surgeon,

northern va

David E. Berman, MD
Sterling Plastic Surgeon
5.0 out of 5 stars 27 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.