Carter Abbott, MD

What the provider does will contribute to swelling, such as how much was injected, how many needle injections were used.

I use ice before and between injections with each patient.  Some people will swell more than others, and if you were showing that tendency I would suggest continuing ice at home, and also use Arnica gel around the edges of the lips, or take Arnica by mouth.

My home care instructions also include no cardio exercise or saunas for 48 hours - this would only make the swelling worse.

I also used "numbing cream" before lip filler.  If you were allergic to the topical anesthetic then you would have swelling.

I would suggest ice and rest at this point for the next 12 hours.  If it is improving, just give it more time. If it is worsening, or if you are having difficulties breathing or swallowing, then go to the closest ER or emergency clinic.

Good luck from Omaha NE

I agree that 3 syringes sounds like a lot of filler.  It may be that you received Juvederm Volbella XC that comes in two syringe sizes - 0.55cc and 1.00cc.  It would not be unusual to use a total of 1cc for both eyes if both the medial (nose side) and lateral (outer side) of both tear troughs were done.  In my experience this filler lasts 12-18 months in the tear troughs, and is a good choice to use.

There are rare cases of filler disappearing within two weeks of administration.  I used to think this was myth, until it happened to me with a lip filler patient.  If this highly uncommon event happened to you I am so sorry, and there is nothing that you can do, other than ask for a partial refund.  

The other thing I am seeing in your most recent photos is puffiness of the eyelids, and this can make the tear trough appear deeper.  Swelling can occur with reduced sleep, increased salt intake and is also common after alcohol use.  I wonder with the holidays that we are now just finishing if that could be a factor.

I would go back to your provider at two weeks and get their opinion.  I will say the immediate post photo suggests that you had the procedure done correctly, so there is no reason here to lose confidence in your provider.

In Omaha NE most fillers are not done by plastic surgeons, but rather by MD's, PA's and NP's who dedicate their time to providing the best non-surgical solutions.  

Good luck and I hope you find an explanation for what happened.

As a non-surgical aesthetic physician I agree that fat grafting is an option.  The skill of that physician will affect your final result.  With two young children, you might want to consider a simpler option.  Non-surgical lifting and volumizing the cheeks can be accomplished with Juvederm Voluma.  I believe this would work very well for you, but you would need at least two syringes and up to four syringes.  Advantages of Voluma are that if you develop "lumps" they can be dissolved with an "eraser" that we call Hylenex (this is uncommonly necessary).  Also, use of a cannula will permit for increased safety of injection and a much lower risk of bruising.

The reason for the change in your facial appearance is the loss of facial fat pads.  Fat pads will melt away over time and this change is independent of your overall total body weight.  Loss of fat pads, causing loss of mid face volume is one of the top concerns of my patients.

Thank you and have a happy and healthy New Year!  Carter Abbott

Hello!  You have a mild sub-mental fat pad that causes the appearance of a double chin on photos.  Common treatments in the US for this condition include surgical liposuction, Kybella injections or freezing the fat (CoolSculpting).  I believe Kybella is the best option for you as you would see permanent improvement after one treatment.  I would estimate that you would need a total of 3 Kybella treatments.  Since the fat cells are destroyed, once you get the final result you are hoping for, then you will not need further treatment.  (Liposuction often leaves small regional amounts of fat.  I have treated two patients with Kybella after liposuction to clean up these residual pockets of fat).  Happy New Year from Omaha NE

Happy Holidays.  The rate of patient satisfaction with Botox is very high, as long as it is done properly.  Almost all patients will repeat Botox again in the future, but I do find that the cost of treatment is a limiting factor for some patients.  Although I have patients who return every 3-4 months like clockwork, there are others that I see only once or twice per year, often planning their treatment to coincide with an event, such as a holiday, vacation, birthday, high school reunion, weddings - when we may want to look our very best.  A small percentage of patients will develop antibodies to botulinum toxin, and find that they have a diminished result or shorter duration of benefit from Botox treatment.  Does this help?

Greetings.  Sorry to hear about your problem with headaches.  Headache pain that persists more than a week after Botox is unusual, but possible.  Other causes of headache pain should be considered.  Rather than go to ER, I would suggest a visit to your regular primary care physician.  If you have irritation of a nerve from a Botox needle injection, then the pain is usually "neuralgic" and feels like a sharp, shooting, burning or tingling pain.  Neuralgic pain can cause muscle tightness in the area leading to more headache pain, and even progress to a migraine headache. Severe headaches with light sensitivity and with or without nausea and vomiting could be a sign of a more serious problem, and would justify a visit to the ER.  Even the most experienced Botox injector will have patients who report neuralgic pain after injection, as there are many small nerves across the face that cannot be seen with the human eye.  Neuralgic pain from a Botox needle injection will go away, but it can take weeks and potentially a few months.  I hope this helps you decide how to manage your problem.  I hope you find a resolution to your problem.

In the part of the USA where I practice, most of us use a blunt tipped cannula to place small amounts of fillers, such as Juvederm Volbella (US names vary from UK labeling of product).  The cannula causes very minimal to no swelling, and the risk of bruising is greatly reduced.  You appear to have swelling, and it would be wise to wait a full two weeks before assessing the final outcome of treatment. It would be helpful to compare your photos with "before filler" pictures.  The other consideration is that some fillers are more or less hydrophilic, meaning that some fillers swell with hydration.  If your provider used a filler that puffs out when you are more hydrated, then the appearance of the under eye area will vary throughout the day.  The use of fillers with low hydrophilicity is best in this area of the face.

Hello from the US.  I have performed many lip augmentations over the last 12 years, and prefer to use Juvederm Ultra XC or Juvederm Ultra Plus XC (this is how they are branded in the US, names in the UK are a bit different).  Small lumps near the surface, on the inside of the lip, is not uncommon after lip filler. I encourage my patients to evaluate the appearance of the lips when they are closed, and with no to minimal smile, and then again with a full smile.  If these two images fail to show visible lumps, then I prefer not to dissolve any filler.  Your first picture on the left shows beautiful lips!  Our tongue is very sensitive at detecting even small surface variations, alerting you of the lumps on the inside.  There are also a couple of other conditions of the lip that cause lumps, other than filler.  If your lumps are still  present in another 6 months, assuming no additional filler has been used, then a consult with a dermatologist, oral surgeon or plastic surgeon would be a consideration.  Happy New Year!

Hello from Omaha NE!  The hollow that you are seeing is the beginning of a nasolabial fold.  The appearance is normal for a twenty year old.  Aesthetically we consider your current appearance normal, and in fact very desirable.  The current hollow can be removed with use of filler but I would discourage you from doing so.  I have had two patients in the last month, in their early 20's who were certain that they wanted filler placed into this area.  Once I determined this was their goal, I provided the service, and they were both happy with the result.  To answer your other question about the changes with aging, the fold will likely deepen over time, which is a normal change with aging.  In an older mature face we typically improve the appearance of a deeper nasolabial fold by adding a filler, such as Voluma on the upper cheek bones, which provides a non-surgical lift.

Oral surgery to remove wisdom teeth will not affect the appearance of or duration of lip augmentation using filler