Lumps on Lips After Juvederm

Question

It is 3 1/2 days after I had Juvederm, and I have a number of bumps on my top lip that create an uneven line when my mouth is open (in addition to discoloration). I also have one large lump on one side of my lower lip. Is this a common result? Will it go away? I am really regretting that I had this done and wondering about the enzyme that can be used to dissolve it. Will it cause another round of swelling/bruising?

Rupert Critchley, MD, MRCGP · Answer

Hi there!I always suggest a period of 7-10 days to allow for any residual swelling or bruising to settle which certainly can cause visible lumps and asymmetry. In the case these persist beyond this time frame please contact the practioner who performed the procedure for further assessment. Hyaluronic acid based dermal filler is reversible. There is an enzyme called hyaluronidase that breaks down the product. I hope this helps!Best wishes,Dr Rupert

Mike Comins, MBBS · Answer

It really repends on what filler was used and where in the lips it was injected.  Injecting  the wrong filler for the lips or injecting too superficially can cause lumpiness. Sometimes however, even a suitable filler injected in the right place results in small amounts of the filler migrating  through the lip structures to the surface of the lips causing this type of lumpiness. I note it’s only been 31/2 days so there is a chance any lumpiness may still be a result of swelling or some deep bruising. I suggest  massaging your lip for the next few days with clean hands. If it doesn’t settle an experienced practitioner can dissolve the fillers with Hyaluronidase and start again. It’s not ideal but at least it gives you some peace of mind that things can be fixed.

Jonathan Amspacher, MD · Answer

The lumpiness immediately after juvederm is generally temporary and is related to swelling and bruising that will improve dramatically over the month following injection.  Anytime that you use a needle to deliver a medication there can be a small amount of bleeding and bruising that you can feel in the area and that is especially true in the lips.  I always try to explain to patients that this can occur in the first few days or weeks after an injection and it generally improves dramatically in the first 2-4 weeks after a procedure.  I would not recommend getting any hyaluronidase injected until at least 6 weeks afterwards because you will almost always smooth out before then.  Best of luck on your recovery.

Anil R. Shah, MD · Answer

Lip filler bumps is fairly common after filler.  The bumps can occur early on and many settle down.  Although massage after filler is considered a mainstay, beware that massage can drive the filler into another location if done too early.  
Reasons for bumps after filler:
Technique- Filler may have been used too superficially or wrong type of filler
Mouth movements- In some patients their movements can promote the accumulation of bumps and an alternative technique can be advocated.
Treating lip filler bumps:
Observation +/- massage-  Should be done for almost all lip filler bumps for 2 weeks.  For our patients we usually advocated massage after 48-72 hours to let the filler settle into place.
Reversal- A reversal agent can be used such as Vitrase to dissolve the filler if there is a large obvious persistent bump
Additional filler- An expert filler injector can used improved technique to mask the lip bumps.
The application of lip filler is very technical and should be done by an expert injector.

Richard J. Bruneteau, MD · Answer

It’s
not unusual for patients to have contour irregularities of their lips
immediately following injections with Juvederm. In the vast majority of patients this is usually related to swelling and
may take several weeks to resolve.Unfortunately
in some cases, these lumps may be related to uneven injection of Juvederm. Under these circumstances, the lumps will
have a characteristic appearance. They
will be firm with a bluish transparent coloration. When
this situation arises they can be removed by either perforating the skin and
extracting the material or using the enzyme hyaluronidase to dissolve the
material.If
you’re concerned about uneven lips following Juvederm treatments, consultation
with your surgeon is appropriate. Your
surgeon should be able to formulate an appropriate treatment plan.

Jerome Edelstein, MD · Answer

It would be best if you book a follow up appointment with your injector in 1-2 weeks, and he/she can massage any residual lumps or bumps at that time. You are still recovering from the treatment and have some swelling as well which tends to subside in a week or two.

Steven J. Pearlman, MD, FACS · Answer

3 1/2 days is too early to start being concerned about lumps in the lips after filler treatment. This is injection of a gel into an area of muscle covered by a thin layer of soft tissue (fatty layer under the skin), then skin and mucosa (the red part of the lip). Just by the nature of the process, lumps can occur since it is impossible to actually layer a uniform amount of filler across the lips. The filler is injected in aliquots, then massaged to make it as smooth as possible.
Some of the early lumps can be swelling from the needle and trauma of injection. You might also have a few small areas of blood under the skin from the needle sticks. Both can cause the lumps as well as discoloration. So, I would give it at least two weeks before considering dissolving the Juvederm. If it comes to that Hyaluronidase can be injected to dissolve the hyaluronic acid.

Spa 35 - Boise · Answer

It is very normal to have some lumps, and bumps after lip injections. It can take up to 2 weeks for the swelling and lumps to subside. I would give it 2 weeks then if you are still unhappy, I would recommend scheduling a follow up appt with your injector. Your injector can dissolve the filler if needed with a solution called hyaluronidase. You are less likely to see bruising when dissolving filler. I would recommend ice to help reduce swelling, and light massage can help too. Hope this helps!

Monika Soni, MD · Answer

Thank you for your question. The lumps you are experiencing immediately after Juvederm is temporary and is most likely is related to swelling and bruising and will improve over the next 2 weeks. You can apply ice to help reduce the swelling and gently massage the lumps to help smooth them out. Please follow up with your injector in 2 weeks for evaluation. Best of Luck!

Tracy Mountford, MBBS · Answer

It is rare to get lumps in the lip. It’s normal for the lip to feel a little uneven, swollen and lumpy for a few days after treatment. This is due to general inflammation and tissue swelling and will calm down on its own.  It is essential to choose a medically trained professional who has experience in injecting the lip area. In the hands of a skilled injector, the procedure is generally very safe and without problems. The choice of injectable filler is relevant too. It’s important to use fillers made from a FDA cleared hyaluronic acid gel. The lip filler should be soft and less dense to ensure that the lips feel natural to the touch. This also reduces the risk of any lumps forming.  Should you develop unevenness and lumps in the lip after swelling has subsided, these can then be easily dissolved by an experienced injector. This is done by injecting an enzyme called hyaluronidase into the area affected and will disappear within a few hours to a few days.

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