Is this lump on lip from filler or swelling after Restylane? (photo)

Question

I had Restylane on the sides of my upper lip a week ago. One side bruised extremely bad and the other has a small, visible knot. I'm afraid if I get the reversing enzyme, it will dissolve all of the filler. Should I wait it out or get it checked out now?

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.

Kenneth Hughes, MD · Answer

Swelling is very common after lip injections, I suggest you wait 2-3 weeks for the product to settle before you see your final result

Michele S. Green, MD · Answer

Sometimes you can be bruised or swollen or lumpy from fillers.  Rather than rushing to have it dissolved it is best to wait two weeks to see if the symptoms resolve and you are satisfied with the results.  If there are still lumps after two weeks then you should return to your treating physician who can dissolve the Restylane in that area alone.

Michael R. Menachof, MD · Answer

It's hard to tell at this point whether the bump is due to swelling or a bit too much filler. I would massage the area gently for 5 minutes twice a day, be patient, and re-evaluate it in 1 week. If it is due to too much filler placed into that one spot, it will be no better in a week and at that point you will have a decision to make; 1. You could try having your injector place a very small amount of hyaluronidase into the lump, hoping to dissolve the lump without affecting the rest of the filler, or 2. If it's not too bad you could just ignore the lump and enjoy the fullness you have overall. Good luck.

Darryl J. Blinski, MD · Answer

Best option is massage and waiting it out as you stated. Also returning to see the injecting doc would be advisable..//

Daniel Shapiro, MD · Answer

As it is still relatively recent since your injections I would recommend waiting for the swelling to subside in order to see whether it is related to the swelling or not. Once the swelling subsides, if the lump is still there then revisit your injector.

Jo Herzog, MD · Answer

I would wait two to three weeks before doing anything. If at this time you still have a lump go see your physician. A lump in this area can be removed through a small puncture so I would not dissolve your product if you are happy with it.

Erica Linnell, MD · Answer

You probably should wait another week to see if this lump will go down.  Your injector can then sometimes get the lump to dissipate with firm massage and a very small amount of kenalog (steroid) injection- Or you can have him/her inject the hyaluronidase.  If you go the hyaluronidase route, it will very likely dissolve the rest of the filler in that lip.  Give it another week and then ask your injector to re-evaluate.Take care,Dr. Linnell

F. Victor Rueckl, MD (in memoriam) · Answer

I would wait at least 10 days after the filler was done to see what is filler and what is swelling. At that point in time swelling should be resolved and you can appropriately determine what could be too much product, vs what is actually swelling. "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."

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