Just curious as to why there seem to be so many differing doctor's opinions on post Juvederm, bumps or lumpiness?

Differing doctor opinions of post Juvederm lumpiness and bumps.....just curious as to why there seem to be somany differing doctor's opinions on post Juvederm, bumps or lumpiness?.... Meaning that some say it is normal for it to occur initially and some state that one must seek medical attention from their injector?

Doctor Answers 10

How lumps and bumps from fillers can be managed, and situations where it is urgent or not urgent to see a doctor

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Thank you for your question. I understand you’d like to know why there are differing doctor’s opinions about how to handle lumps and bumps after Juvederm, and why some doctors’ answers range from conservative to a bit more aggressive.

To first give you a bit about my background — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I’ve been using fillers for that long as well, starting with the original Zyderm and Zyplast.

When it comes to lip augmentation, I believe in a natural look because the lips are a critical part of facial harmony. When lips look disproportionate or unnatural, they naturally draw the focus of people’s attention.

There is a certain artistry needed when using filler - the filler is the material, and the doctor is the sculptor who has a vision as to what the lip should look like, and how to employ that filler. What I’ve found to be quite useful in my practice is the Golden Ratio of 1:1.6 for the upper lip to the lower lip, or the one-third to two-thirds rule, in terms of lip volume. Keep in mind that when you’re treating the lips, you’re not just treating one area: there’s the volume in the upper lip, volume in the lower lip, the border of the upper and lower lips, and there’s the corners — there are many areas where fillers can be placed, and following the Golden Ratio has always helped in achieving proper balance.

When volume is placed into the lip, you can expect some short-term reactive swelling, which can in turn camouflage the presence of any additional material causing a small elevation or a bump. Lumps or bumps in the very early stages can be normal if they are not too obvious, and the movement and activity of the lips can actually help massage the material into place.

In my practice, I usually have my patients see me again after two weeks, so I can see how everything looks and whether there’s a need for enhancement. Other scenarios of concern that will prompt a more urgent response from physicians are cases when there is pain, inflammation, or infection involved; or if the material becomes hard under the skin. In general, if there are subtle irregularities which are not disfiguring or too obvious, and there are no other unusual symptoms, then usually waiting is appropriate.

Unfortunately, nowadays, fillers are so commoditized, with people seeking cheaper prices and treatments to the point of having non-physicians administer the treatment. Remember, choosing the right doctor is not about buying a syringe of a filler. In addition, there is often a compromise in the quality of the follow-up care because there is a diminishing of the seriousness regarding injectable fillers. Fillers and injectables are actually considered invasive procedures, comparable to surgery, because you are going through the skin and placing a foreign material under the skin.

With regard to doctors’ differing opinions, I think it is understandable and natural that when someone posts photos of their concerns, that a doctor will respond by saying “seek medical attention.” Ultimately, I would say that the close relationship of the doctor who performs the injectable and the doctor who is able to properly examine you determines whether or not something is more urgent or less urgent. It’s really all about long-term clinical relationships and knowing the patients well. In my practice, I see my injectable patients for a long time because this is the type of procedure that requires maintenance. We certainly get to know them and what they like very well in that time.

Ultimately, there are things that can happen short-term and long-term that do require medical attention right away, but generally, volume correction in the lip area does require about two weeks to allow for normalization without urgent intervention.

I hope that was helpful and I wish you the best of luck!

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Bumps or lumps after Juvederm Injections

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Dear Missy56, You will often get varying opinions from surgeons however the general consensus is that on occasions some patients may experience some lumps or bumps after the injections for the first few days. If these do not resolve then seeking attention from your injector is the next step so that an evaluation may be performed. After a proper diagnosis then the medical injector can determine if these will resolve on there own or if treatment with Vitrase would be suggested. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Bumps and Lumpiness from Juvederm

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Any filler can give temporary lumpiness or bumps, but many times these types of problems are due to injection technique.  I strive for the smoothest possible results when I inject filler and usually don't see significant lumpiness or bumpiness.  It is normal to be able to feel the filler in some areas for the first few days after injection.  Injection technique is extremely important for best results with filler treatment.  

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews

Juvederm bumps

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It is rare to get bumps from juvederm. If you get them it is always a good idea to contact your doctor who did your injection. Often the bumps will disappear within a week with gentle massage. If not they do respond to hyaluronidase injections. 

Rebecca Baxt, MD
Paramus Dermatologic Surgeon
4.8 out of 5 stars 29 reviews

Lumps from Juvederm

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Initially you may have some lumps from Juvederm. If after two weeks you still have lumps then it may be from too much product or the placement of the product and require Vitrase.  Best, Dr. Green

Uneven volumization of the lips

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It is a diplomatic way to say "go back and see the provider" as there is asymmetry or uneven injection.

Dr Karamanoukian

Lumps After Fillers -- Not Normal, There are options!

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I suggest reversing fillers if they do not give the optimal outcomes.  Please see an expert and use cannulas to avoid complications. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Bumps and lumps can occurs after filler but most go away

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The usual time period is about a week for these to get better. If they are persistent and bother you, seek attention at that time. Very large bumps won't get better even with waiting and those are people that should see a doc sooner. See link.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Just curious as to why there seem to be so many differing doctor's opinions on post Juvederm, bumps or lumpiness?

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Hello Missy56,

If you talk to two different physicians you'll get three different answers.  But to be serious it is normal for there to be a little lumpiness for the first few days after an injection.  This is because of swelling and there is usually more swelling where the needle is inserted. This should completely even out within a few days.  When the lumps persist this is a result of the injection and would not likely improve on its own.  This is when you will se us recommend he or she follows up with the injector for treatment.  The treatment may be massaging (which I like and have all of my patients do for the first 3 days to minimize the risk of lumpiness), adding more filler to even out (this is not usually done for lumps but rather asymmetry), or dissolve the product and start over.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Why do opinions differ about lumpiness from fillers

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I'm not sure opinions differ exactly. I think we are talking about lumps or bumps in different areas. In the lips you will generally have some lumpiness or bumps as the filler settles down. In other areas this would not be the case and fillers should inject into some areas more smoothly than others. So I'm not sure we all have that different of opinions on if there would be lumps or not, but more about where those lumps can occur and when they should not.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.