Adrian M. Guevara, MD

By two weeks that puffiness should have resolved, if it were going to resolve.  At the very least the puffiness should be improving steadily.  The product looks like it was placed or migrated superficially into the subcutaneous compartment, instead of above the periosteum (just above the cheek bone).  The product on the right has tented up the cheek evenly and looks great, providing a solid new foundation.  The product on the left may have slipped through the tissue and is not raising up the cheek skin and muscle.  Reversing that pool of product and adding more product deeper at some point makes sense.  This problem looks quite correctable, so keep at it!

Hyaluronic acid fillers can be rapidly reversed by injecting hyaluronidase.  Alternatively, for very bubbly, superficial lumps of filler, a tiny stab incision can relieve the pressure of these collections of filler instantaneously.  It's always a downer to deal with imperfect placement of fillers in the lips, but I recommend you keep working through it with an injector that you trust.

It's my opinion that a small volume of a local injection of hyaluronic acid with lidocaine (most versions of fillers now come mixed with lidocaine) should pose virtually no risk of significant systemic absorption and reincorporation into breast milk in enough concentration to hurt a baby.  As a medicolegal and common sense precaution, most providers in the USA do not inject cosmetics into pregnant and breastfeeding patients.  While you could pump and dump to play it extra safe, I would not recommend that for more than a day in this scenario.

The thinner versions of Juvederm tend to swell the areas under the eyes and in the lips not infrequently.  I am not aware of any aftercare that will significantly reduce this reaction reliably.  In my practice, I won't offer this filler in the lips or under the eyes unless the patient has already had a good response in those areas.  The product is hydrophilic which means it is designed to draw in water, and many times it's scary for the patient how much the area swells.  My recommendation would be to switch to a firmer filler that is less hydrophilic.  I get as good or better results with other hyaluronic acid fillers, including the Voluma version of Juvederm and the firmer Restylane products.    

I don't buy lack of sleep as an explanation for the changes you're seeing. I believe you could sleep for 24 hours straight and still look the same.  Actually, your generation is no longer tolerating normal aging. Sculptra is an excellent way to stay young indefinitely. A high percentage of patients have relatively quick and lasting success with few treatments at your age as opposed to waiting until the lines are more firmly etched in your skin.   I think you should go for it.  Best of luck.