After Juvaderm Voluma in my Cheekbones, Swollen and Uneven Face

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.

Hi there! Thank you for your question.I would always recommend a 2 week settle in period as some of the asymmetry may be due to mild swelling / bruising after injections. At this point ensure you have follow up with the injector to review results and decide on your plan moving forward. Hope this helps!Best wishes, Dr Rupert

Swelling can persist for several days after injection of any filler product. If there is significant asymmetry, it is best to talk with your injector. This could be due to technique, or simply due to bleeding, bruising, or swelling under the skin. In most cases, mild asymmetries will even out with time, but every patient is different.
Always see an expert physician injector.
All the best,

Swelling after Voluma can be a result of the following factors

-Deep bruise- Not all bruises are at the surface and this localized swelling can take weeks to dissipate

-Injection technique- Injections of the product can create depositions which can create lumps if not properly transitioned.  Since Voluma is not hydrophilic (does not tend to absorb water), Voluma tends to be a what you see is what you get type of filler.  

Consult your treating physician for the best course of action.  

With the initial swelling post Voluma treatments, there can be lumps, bumps and asymmetry. Contact your injector to let them know what you are experiencing. Give it at least 2 weeks for things to settle down and even out. If at that time you are still unhappy with your results, let your injector know and they can determine if more product would be beneficial or if dissolving the product would be an option for you.

Usually the next day after injecting Voluma you can get an initial phase of swelling then it dissipates after couple days.  Swelling can last longer especially if you have some blood underneath which will be absorbed.  I massage my patients on the day of injection to smooth out any uneven areas only if I have to.  I think it's just too early for you to evaluate whether the swelling is due to tissue trauma or the product itself.  Your doctor will be the best person to judge.  I think it's reasonable to wait another day or two, however, the swelling should not get worse.

Hi there, that does sound stressful. It is not uncommon though to have swelling after Voluma injections, they are placed very deep and can cause surprising swelling, even on one side more than the other. This usually goes down, but can take a week to 2 weeks, but likely within a week. You can sleep on several pillows, and sleep on your back propped up. Take ibuprofen, if you otherwise have no health issues or contraindications. If after time has passed and you still see asymmetry definitely follow-up with your doctor and see if massage can help, or if additional filler needs to be placed in the other side. If there is asymmetry I would favor the option of putting in more filler to correct as opposed to dissolving fillers, because it is difficult to control fully how much product is going to be dissolved, and this would be a waste of filler. That being said, give it some time, and hopefully this is all just secondary to swelling from the trauma of injections.

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)

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!

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