Lumps, sagging lips, and smokers lines well after injection - can I try anything else? (photos)

Question

I’ve had lip fillers a couple of times (volbella). Each time I develop lumps after a few weeks and have had to have them dissolved. I’m wondering if there’s another product I might be able to use that will work but not become lumpy, or if this is just how my body reacts to fillers :( If not, what else can I do to help my smokers lines and sagging lips?

Kenneth D. Steinsapir, MD · Answer

The big problem you are having with fillers are injectors who do not understand what they are injecting. It is not entirely their fault.   Sadly most injectors simply believe marketing hype and do not investigate things for themselves. They uncritically believe marketing when they are told products like Volbella, or Juvederm are good for lip effect treatment. Virtually all fillers that are marketed for the lip edge are runny. That means that once placed, the product will not hold as it was originally place.  Rather it migrates out of the tight lip edge to create a lip shelf or fullness in the mouth corners. The solution is to avoid these runny products. It is actually helpful to use a product with a very high g prime. Restylane is actually a fantastic product for lip edge treatment.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. It isn’t typical for patients to always experience lumps after dermal filler injections. Also, lumps as a side effect should be felt or seen days after treatment and should resolve within 1-2 weeks. Perhaps, you might need another type of filler and a more experienced and skilled injector to perform the treatment. In addition to dermal fillers, treatments for smoker’s lines include lasers, chemical peels, RF microneedling (Profound RF), and other treatments that stimulate collagen production.

The best way to find out the best approach for your lip augmentation and smoker’s lines treatment is to have an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with extensive experience with injectables and other techniques for skin rejuvenation. Your surgeon can assess your lips and skin quality, recommend and customize the best procedure plan, and ensure the best possible results.

Marc Polacco, MD · Answer

Thank you for your question. While a fine filler like volbella can help somewhat, I find that often the results are underwhelming. For smoker's lines, I prefer either laser resurfacing or a chemical peel. This will help efface the lines and rebuild collagen. Regarding a sagging lip, a lip lift is really the only treatment for that. Fillers add volume, but cannot shorten the lip itself. I hope this information is helpful to you, and all the best.
-Dr. P

Daniel Barrett, MD · Answer

Dear Belli612,
I perform a lot of lip injections with fillers such as juvederm and it works great. Many times I need to put more in one side than the other to attempt to even out the vermillion border (The red line of the lip). This helps provide more symmetry at times.For patients looking for a more long lasting result, I recommend fat grafting. That is, using your own bodies fat to make your lips naturally look more shapely. The bonus is that the results last many many years.
In general, I avoid using permanent prosthesis because I find that the lips are such dynamic and sensitive structures, the end result is not natural.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Andrew M. Ress, MD · Answer

After trying multiple fillers we found that Restylane Kysse is a great filler that does not cause lumpiness if injected correctly in the lines above the lip.

Mobin Master, FRANZCR, MBBS · Answer

I always suggest to my patients avoid using straws, smoking and try not to lazer / damage hair follicles above the lip - it’s provides support.Other products l, which are not as “thick” fillers, can be an alternative in combination with some botulinum toxin A.

Mats Hagstrom, MD (license on probation) · Answer

Smoker lines are a challenge. There is no one single best treatment but probably the best option is well done lip fillers combined with carefully placed Botox.

When doing lip fillers there are two basic approaches to treating smokers lines.  when is simply creating volume to put the skin under gentle tension. The other option is directly injecting each deep wrinkle line and filling in the skin.  The second option can create a bulky appearance and choosing the right provider is absolutely paramount since this is a finesse procedure.

If you had poor results with lip fillers previously it is your choice of provider not the product itself.

My personal preference for lip volume augmentation is Voluma.

Botox works by partially paralyzing the lip muscles. It basically has the opposite effect of puckering your lips.

Paralyzing lips comes with a drawback. In particular it may be challenging to drink out of a straw and balancing the dose and placement of the medication to get a perfect balance between ideal aesthetic outcome and minimizing dysfunction is the difference between talented and experienced providers and the rest.

For lip Botox treatments it is often a trial and air adjusting the dose and placement with each treatment.

Low-dose Botox treatments rarely last more than a couple of months so it is something requires ongoing maintenance which may or may not be to everyone’s liking.

Skin resurfacing techniques tend to be temporary and in the end fairly unsuccessful.

Daily sunscreen goes without saying.

In the end finding the right provider is by far the most important and biggest decision

How to find the most talented provider for these treatments is easier said than done and often requires having multiple consultations.

Good luck,

Mats Hagstrom MD

Angelina Postoev, MD, FACS - Account Suspended · Answer

By best advice is to find another injector. It’s not you or the filler. There are dozens of fillers. And that area can be refreshed very well with more advanced techniques. Probably more then one syringe&hellip; closer to 5. Your injector needs to recommend products or use what’s appropriate, not you telling them what to use. Add RF Microneedeling for overall skin tightening.

Lumps, sagging lips, and smokers lines well after injection - can I try anything else? (photos)

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