One cheek higher 5 days after Voluma injections, should I do something or it give it some time? (photo)

Question

Hello! I had 2 syringes of voluma injected 5 days ago. I love the results. Very little bruising and not much swelling. They looked even too. Last night I gave in to sleeping on my sides a bit. I did notice my right cheek hurt a bit more this morning and it looks higher and harder than the left. Not sure if I should do anything or simply give it some time to see if it resolves itself. Could the fact that I slept on it a bit last night cause the voluma to "shift" somehow?

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. You may be experiencing some mild swelling. Some patients are more sensitive than others, but side effects will fade within 2 to 4 weeks and the only noticeable results will be enviably youthful cheeks. Please discuss your recovery with your board certified facial plastic surgeon.
Best wishes,

Nima Shemirani, MD · Answer

Hi @Monika84123. I recommend waiting a full two weeks to see how the product settles in. If one cheek is still higher after two weeks,  you can add additional filler to even them out. Best of luck, Dr. Nima!

Sabrina Fabi, MD · Answer

Don't worry! It's highly unlikely that any sleeping or leaning position could affect your Voluma. It's perfectly normal to notice some asymmetry in the face during the first couple of weeks after having your cheekbones or midface rejuvenated with Voluma; it takes at least two weeks for the swelling to completely subside and for the product to fully integrate with the inner layers of your skin. Give yourself another couple of weeks. If you still notice some asymmetry at that point, consult your board-certified dermatologist for a touch-up.

Payman Kosari, MD, FAAD · Answer

Give it two weeks and if it is still uneven, have them compare your before and after photos for evaluation.  Most people are not symmetric to begin with and photos can be helpful in this instance.  It can always be dissolved if needed but your results look good for being 5 days out.  Best of luck!

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  In the first few days after filler placement you can have a "sharp" look to the area of treatment which typically softens over the first 2-4 weeks.  Because Voluma is a very thick gel, and placed deeper into the face it is unlikely that you shifted it.  I would advocate allowing your results more time to mature, you can speed healing by sleeping with your head elevated with an extra pillow or two behind your back and consider arnica montana/bromelain supplementation.  Hope this helps.

Kouros Azar, MD · Answer

You are probably having a bit more swelling on the one side than the other. This is common. It may take 2-4 weeks for your final results so, for now, be patient. Hopefully, this will resolve on its own.

Karen Beasley, MD · Answer

I wouldn't assume that the asymmetry you are seeing has anything to do with the way you slept or that your Voluma has become misshapen. That is highly unlikely! Voluma is injected deeply into the skin and should not be affected by sleep position. What you are seeing is probably just some residual swelling that will resolve in a couple of weeks, maximum. Consult a board-certified dermatologist who is an expert at reshaping the face with Voluma and other dermal fillers if you don't see a good result in two weeks.

Renata Wix-Harris, MD · Answer

It is unlikely that sleeping on your side caused enough pressure for the Voluma to shift. It is most likely caused by swelling, which can last a few weeks. Sleeping at a 45 degree angle and avoiding too much salt and alcohol can help with that.  I usually wait at least 2-4 weeks before performing any adjustments on my patients. Good luck!

Larry Lickstein, MD · Answer

Thanks for your question, Monica.  I agree with my colleagues that it is not uncommon for patients to notice asymmetries early after filler injections.  It may be due to underlying anatomic differences between the left and right side of the face, injection technique with uneven volumes or patterns of distribution, or asymmetric swelling which could be influenced by things like sleeping position.  I would encourage you to keep your head up, employ cold compresses, and consider taking arnica.  Too many injectors do not routinely see their patient 1-2 weeks after treatment, but it is my general practice.  I would encourage you to follow up with your provider for an assessment and treatment, if necessary.  Best of luck!

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting your photo.  It is not uncommon to experience swelling for up to 2 weeks after any filler injections.  This swelling can sometimes be uneven, which can temporarily make the cheeks appear asymmetric.  It's difficult to assess what your final results will be until your swelling have fully subsided.  While I can't make exact recommendations without assessing you in person, it's unlikely that the pressure from sleeping on your side was sufficient to displace your Voluma.  
For now, I would suggest gently applying ice or cool compresses to your cheeks.  I also find that taking over-the-counter antihistamines like Zyrtec or Benadryl can help with swelling after fillers.  If you are still concerned about the appearance of your fillers after 2 weeks or so, it would be worthwhile to follow-up with your injector to discuss your concerns.  If necessary, Voluma can be dissolved with hyaluronidase, though it may take more than one treatment to fully reverse its effects.  Best of luck!

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