Dealing with the Aftermath of Juvederm

Hi Ros,

You should be seen by your injecting physician immediately!  You are having signs of vascular compromise.  Whenever there is unusual bruising accompanied by blistering, swelling, and pain, patients need to see their physician immediately.  I hope that your lip recovers.  Good luck and be well.

Dr. P

Your story is classic for what happens when dermal fillers incidentally compromise the blood supply to the skin or mucosa ( inside skin of the mouth). Initially you will see blue /black discoloration, swelling and pain that is out of proportion to the expected post procedure pain. If the blockage is superficial, tiny pustules develop on the surface and are often misdiagnosed as signs of an infection (herpetic or bacterial). Within 7-10 days the area will heal although is may remain red for some time. If the blocakge is deeper, more significant breakdown can occur and the area may scar. Many doctors do not recognize the more superficial cases like yours. The good news is that they nearly all resolve without any problems. I hope you are doing well.

Bruising following lip filler injections can usually be prevented by applying pressure immediately following the treatment and then applying ice packs for 5 to 10 minutes.   If you are going to have lip injections, do not take aspiring or ibuprofen or other medications that cause bruisingut  for about one week prior to the treatment.  Now that you have bruising, it will go away in a week or two.  if you can take some arnica Montana, available at health food stores, to help your bruising go away a little faster.  You could also have your lips treated with low fluence pulsed dye laser by an expert laser doctor.  This makes the bruising go away about twice as fast.

JUVEDERM is a popular dermal filler that is available in two thickness/viscosity.  Like any dermal filler, the results are determined by the injector, i.e., their technique, choice of product thickness and amount used. The patient’s skin texture and thickness/thinness and the physical structure of the area being treated also plays a large role. 

Dealing with the Aftermath?  Should you receive results that are not pleasing to you, there is a product called Hyaluronidase that can be injected into the site to dissolve the JUVEDERM product. 

I want to reassure you that bruising after Juvederm injection to the lips can happen and will resolve completely in 7 to 14 days. Next time, ice pack application to the injected areas for the first 24 hours can be very helpful. You do not have to do it all the time; just fifteen minutes of every hour should be fine, until you go to bed. Avoid taking aspirin, ibuprofen, vitamin E for seven to ten days prior to the procedure. Also, if whitish blister-like lesions are appearing at the site of injection and bruising, and you have a history of cold sores, you should contact your physician and inform him/her. This break out can be easily treated with just a few days of an oral medication. Best of luck, and I hope after all the bruising is gone you can enjoy your beautiful lips!

Bruising and swelling is uncommon when Juvederm used on the nasolabial folds but is much more common when injected into the lips. Everyone is different but typically it can last up to 7 days.

The presence of small "pimples" in the area of injection can be a herpes eruption (cold sore).  That needs to be treated with anti viral medications.  Most likely the pain you are experiencing is a combination of the hematoma and a herpes breakout.  Please see your doctor as soon as possible to treat both. 

Patients with a history of cold sores need to be prophylaxed with an antiviral medication, like acyclovir, valacyclovir or famacyclovir.

Bruising is  potential complication of any injection, especially in a very vascular area like the lips.  Taking any blood thinners within 10 days prior to injections increases the chances of bruising.  These blood thinners include both prescripiton medications, like coumadin, plavix and others, and non prescription, like aspirin, vitamin E, gingko biloba, ginseng, fish oil/omega 3.

Also, applying vitamin E topically can result in a contact dermatitis (allergic reaction) which can also present as small vesicles.

Bruising after a filler, such as Juvederm, can happen especially in the lips which are very vascular. Vitamin E does have some anticoagulant properties so I would recommend you discontinue that. Regarding the pimple, perhaps the oil from the Vitamin E capsule caused some occlusion inducing an acne like lesion. Bruising typically lasts several days to a week and generally has to run it's course since there is little one can do to speed it's resolution, a little cover up shouldn't harm things if you have to go out. Did you take any medications prior to your recent injections that would have made you more susceptible to bruising such as aspirin, Morton, Nuprin, Vitamin E, or St John's Wart, etc.

The lip is very vascular and whenever a needle is inserted one can hit a small vessel and will result in bruising.

Bruising in the lip and eye lids is more common than other areas. Just ice and elevation of the head.

Have your surgeon see you ASAP to make sure no hemetoma that need aspiration.

Unfortuantely bruising after hyaluronic acid fillers in the lip is very common.  I would not recommend using Vitamin E for bruising or swelling because sometimes this can worsen the bruise.  In addition, I try to avoid over the counter antibiotic creams because they commonly cause allergies.  Two of North America's top 10 allergens are found in those over the counter topical antibiotics.  The oily nature of the Vitamin E and antibiotic products likely created the pimples.  Do not worry, they will go away and not scar.  Now, as for the bruising.  Pulsed dye laser is now becoming a mainstay for bruising.  This is done using doses that are very low for its traditional use and has a tremendous safety profile.  I usually offer this to my patients who receive fillers.  Furthermore, you could consider Arnika forte pills or topical ointment for the bruising afterword or prior to your next procedure.  This has been reported to mitigate bruising.

Good luck,

dw