This article has been medically reviewed for accuracy by Plano, TX facial plastic surgeon Dr. Vu Ho on March 11, 2022.
The outcome of any filler procedure depends far more on the person injecting the filler than the filler itself. While anyone can stick a gel-filled syringe into a face, the very best injectors are scientists and artists, in equal measure. Beyond grasping the unique properties of myriad hyaluronic acid (HA) gels and appreciating the anatomical intricacies of the human face, they’re masters of light and shadow, proportion and perspective.
Even so, delivering da Vinci–caliber work every time is nearly impossible. Sometimes results don’t align with expectations. Filler is overdone or imperfectly placed. Or side effects sully the final rendering, temporarily distracting from its finer points. Anyone who’s ever had filler has likely experienced bruising, swelling, lumps, or asymmetries. The unluckiest of patients can attest to more unusual and troubling complications, like vascular occlusion or persistent nodules.
In these moments, we find ourselves glued to the mirror, studying our filled faces and fully regretting what feels like an expensive mistake. Having been there, we know that the worst thing you can do in this situation is nothing. If you’re less than thrilled with your filler results—at any time, for whatever reason—talk with your injector. They should be “guiding you through the injectables process, not only during the procedure but afterward too,” says London-based plastic and reconstructive surgeon Dr. Ashwin Soni. Ideally, they will have briefed you on what to expect following injections and provided you with an after-hours contact number. Don’t hesitate to use it. But before you do, review these tips for navigating the post-filler period like a pro.
Know what’s normal and what’s not following filler injections
“For the first few days after filler, it’s normal to have some swelling, bruising, soreness—not severe or acute pain—and small lumps or bumps,” says Dr. Jessica Weiser, a board-certified dermatologist in New York City. These harmless side effects typically resolve on their own within a week or two. However, some forms of discoloration and discomfort can signal a vascular occlusion or blocked blood vessel, which demands urgent care. According to Dr. Annie Chiu, a board-certified dermatologist in Redondo Beach, California, red flags include pain that seems sharp and surprising; bruising that’s lilac-to-purple and mottled with white; and the onset of pustules or very red, inflamed skin. “This spreading, lace-like discoloration may be hard to distinguish from regular bruising,” she says, “but if it’s accompanied by worsening pain, there should be an immediate call to the office, as the concern here is vascular compromise.”
Some puffiness is a given following any injection, but this is particularly true with HA fillers, notes Dr. Weiser, “because they draw up to 1,000 times their weight in water.” Since swelling can temporarily alter the contours of the face and breed asymmetries, “you cannot evaluate the aesthetic results of filler during the hours-to-days [post-injection] time frame,” explains Dr. Jennifer L. MacGregor, a New York City board-certified dermatologist. If one side of your jawline, for instance, was more deficient than the other at baseline—meaning that there was a greater degree of bone loss or fat atrophy—it may require more filler and “you might have more swelling or bruising in areas that needed more injections,” she says.
Lumps and bumps are another common concern following filler—but again, most disappear as the filler settles. “Subtle bumps that you can feel but not really see are normal initially, at least until the product integrates into the tissue,” Dr. MacGregor notes. “Visible bumps that get worse or occur at a delay [weeks after injection] are rare, but you should contact your doctor for evaluation and treatment if this happens to you.”
Common filler side effects and their remedies
While it’s comforting to know that a bruise or bump is “normal,” reassurance alone won’t speed its resolution. Fortunately, there are ways to quell minor filler side effects. Homeopathic remedies, like arnica and/or bromelain, applied topically or taken orally can help lessen swelling and bruising after injections. If you really need to fast-track a black-and-blue, “vascular laser therapy can significantly reduce the duration of bruising,” says Dr. Weiser. Bruises tend to respond best when treated within the first 24 to 48 hours following injection, she adds.
To take down swelling, your injector may suggest intermittent icing, skipping alcohol and salty foods, sleeping on your back with your head elevated for a couple of nights, or popping a Benadryl or ibuprofen. “Some areas, like the lips and under-eyes, can swell very significantly in certain people, to the point of discomfort,” Dr. Chiu tells us. In these cases, she may prescribe a low dose of oral prednisone (a steroid) or a diuretic to tamp down puffiness. Dr. MacGregor will also consider a short course of prednisone for severe inflammation or lingering asymmetries.
For bumps that turn up immediately after treatment, some injectors recommend very lightly pressing or massaging the area, to help smooth out the gel, while others advise against manipulating HA filler in any way during those first few weeks, for fear of displacing the gel or exacerbating swelling. Ask your provider what they recommend.
Explain to your injector precisely what’s bothering you
The moral of the story thus far? If you feel at all unsure or panicky about how your filler looks or feels, it’s a good idea to call your injector. But first, figure out exactly what’s bothering you—Are you swollen? Lumpy? Lopsided? Does your mouth look funny in motion?—and how you can best articulate it. “Use precise language to convey what you are dissatisfied with,” says Dr. Chiu. For starters, “are you worried about a reaction to the treatment—or do you not like how it looks?” If pain is the issue, be ready to describe it: Is your face merely tender to the touch, or are we talking unrelenting agony? If there’s a bump, where is it? Can you see it or only feel it? Is it causing obvious facial distortion?
After fielding your complaints and ruling out serious complications, your injector may have some questions for you. “As a provider, I want to know not only what they are feeling or experiencing but if anything has changed since the procedure,” says Dr. Soni. Filler delivers immediate results, he notes, so if you were ecstatic leaving the doctor’s office but are now deeply dissatisfied, what happened in the interim?
If side effects have surfaced, Dr. Weiser will inquire about potential triggers, like salty foods and preservatives (such as MSG), alcohol, strenuous exercise, and air travel, which can exacerbate swelling and bruising. She’ll ask about possible facial massage and trauma—or if you’ve been sleeping on your face and compressing the filler. And especially in the age of COVID-19, she’ll need to know if you’ve recently been ill or vaccinated or had any other medical procedures, which could be stirring up inflammation.
Use photos and videos to help you communicate concerns
Oftentimes, doctors will ask for well-focused photos, videos, or a quick Zoom session so that they can actually see the issues you’re describing. If you think your expressions look odd, insist on video in order to give the truest sense of how you appear when animating or speaking.
If your injector requests still photos, “have someone else take them for you, as selfies can be a bit more distorted,” notes Dr. Chiu. She finds it helpful if patients outline areas of concern with eyeliner, since subtle bumps and asymmetries can be hard to spot in pictures.
Dr. Soni suggests taking photos of the face from various perspectives: two front-on shots—close up and slightly pulled back—as well as left- and right-side profile pics and a 45-degree view of both sides. “If you have a white or neutral-toned wall behind you, that’s even better,” he says. Aim for strong natural lighting, he adds, but don’t stand directly under a bright light, as it can cast significant shadows. Avoid car lighting too, adds Dr. MacGregor—it varies too much with the time of day and angle of the sun.
Wait at least two weeks before tweaking your filler
Since short-term filler side effects are incredibly common—and can absolutely obscure your real results—most injectors won’t want to see you back in the office until two to three weeks after your initial appointment (barring emergencies, of course). This window allows for bruises to fade, swelling to subside, and filler to “settle,” as they say. “Filler is injected in droplets or depots,” Dr. MacGregor explains. “Over days to weeks, it spreads out and gets integrated between your own collagen fibers into the skin or into the fat and soft tissue above the bone.” But it’s not a super-predictable process. “Each area or plane [of the face] has its own settling pattern,” she adds. “I give people an idea of what to expect in general, but every individual experience is a little different.” Only once bruises and fluids have cleared, and the gel has nestled into your tissues, can you accurately gauge what your filler looks like.
If, at that point, you’re still unhappy, your injector can add or subtract filler, to help solve your specific problem. If you feel that you’re overfilled or have too much HA in a certain spot, your provider can partially dissolve the gel with a small amount of the enzyme hyaluronidase. “If the issue is symmetry—if there’s a disparity between the two sides of your face—filler or dissolver can be used to balance things out,” Dr. Soni says. Whether you reduce one side or enhance the other will depend on which side looks best to you and your doctor.
“In a lot of cases, patients feel underwhelmed by their filler treatment, likely because they weren’t fully corrected,” Dr. Chiu says. This could be due to the cost involved or because the injector and/or patient chose to take a more conservative approach. That said, even a syringe or two of filler, injected strategically, can have a remarkable impact. The thing is, “it’s hard to remember exactly what you looked like before treatment,” Dr. MacGregor says. And odds are, you weren’t analyzing your reflection as critically before filler as you are now. Which is why, oftentimes, before tweaking filler in any way during a follow-up visit, injectors will pull up your before images, recap your original concerns and goals, and take current photos so that, together, you can compare how you looked prior to treatment to how you look now.
Ultimately, whether you’re aiming for full-face rejuvenation or single-feature optimization, filling gradually—in stages, over time—will deliver the safest, most natural effect. And finding an injector who follows this philosophy can help make filler remorse a thing of the past.
