Why does my face feel heavy, pressurized and achy after filler in the cheeks, nasolabial folds and marionette lines? (photos)

I'm sorry to hear about your discomfort following your filler treatment. Several factors could contribute to the sensations and changes you're experiencing. Here's a detailed explanation of possible reasons and some advice on next steps:

### Possible Reasons for Your Symptoms

1. **Volume and Placement of Filler:**
- **Heavy Feeling and Pressure:** Even though 3ml of Juvederm Voluma is considered a relatively modest amount for the entire face, the placement and distribution are crucial. If too much filler was placed in certain areas or if it was not evenly distributed, it could lead to a feeling of heaviness and pressure.
- **Aching:** This could be due to the filler pressing on nerves or causing inflammation in the tissues. Some people may be more sensitive to these changes, and the sensation can persist for weeks.

2. **Edema (Swelling):**
- Swelling can sometimes persist longer in certain individuals, especially if the body reacts more intensely to the hyaluronic acid in the filler. This prolonged swelling can contribute to the sense of pressure and discomfort.

3. **Tissue Response:**
- Your body's natural response to the filler could include inflammation or a mild immune response, leading to prolonged discomfort and a feeling of fullness.

4. **Incorrect Placement or Overfilling:**
- If the filler was placed too superficially or too deeply, it might not integrate well with your tissues, causing unnatural pressure and altering facial contours in an undesirable way, such as creating jowls.

5. **Formation of Granulomas:**
- In rare cases, the body can form small nodules (granulomas) in response to the filler, which can cause discomfort and changes in the texture and appearance of the skin.

### Addressing the Issue

1. **Consult with Your Injector:**
- The first step is to return to the practitioner who performed the procedure. They need to evaluate the areas treated and assess whether the filler has been placed correctly and if the amount used was appropriate for your facial structure.

2. **Possible Dissolution:**
- If the filler is indeed causing significant discomfort and undesirable changes, you can consider having it dissolved. Hyaluronic acid fillers like Juvederm can be dissolved using an enzyme called hyaluronidase. This should be performed by a qualified medical professional who can accurately target the filler and minimize potential complications.

3. **Second Opinion:**
- If you're not satisfied with the response or care from your initial injector, seek a second opinion from a board-certified dermatologist or plastic surgeon who specializes in facial fillers. They can provide an objective assessment and suggest the best course of action.

4. **Management of Symptoms:**
- In the meantime, managing discomfort with over-the-counter pain relief (such as acetaminophen or ibuprofen, if not contraindicated) and applying cold compresses might help reduce swelling and pain.

### Prevention for Future Treatments

1. **Thorough Consultation:**
- Ensure a comprehensive consultation next time, where the injector thoroughly reviews your facial anatomy, discusses realistic outcomes, and plans the treatment conservatively.

2. **Experienced Injector:**
- Choose a highly experienced and board-certified injector who has a strong track record with facial fillers.

3. **Start Small:**
- If you’re anxious about the volume, you can request to start with a smaller amount and gradually build up if needed. This approach allows for more controlled and natural-looking results.

### Conclusion

The feelings of heaviness, pressure, and aching you’re experiencing could be due to a variety of factors, including the volume and placement of the filler, your body's response, or potential complications like granulomas. Consulting with your injector or seeking a second opinion is crucial for accurate diagnosis and appropriate management. Dissolving the filler might be a viable option if the symptoms persist and are significantly affecting your comfort and appearance.