Bumps on lips 2 weeks after filler. My injector says to massage them with firm pressure. Will this make them go away? (photo)

Thank you for your question. You describe that it has been two weeks since you underwent lip fillers, and you have several bumps in your upper lips, especially when you smile. The injector advised you to massage this area. You are aware of potentially having this material dissolved, but you are hesitant to go that way because it takes awhile for you to recover from bruising and swelling, and you take time off when you have lip filler, and you work in a job where you serve people. You are caught in a situation which is a bit challenging because you are concerned about an appearance and you are of course concerned about any downtime related to any corrective action.
I can share with you my thoughts on this situation based on the limitations of your history in the photos, and in the absence of a physical examination. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with their lip aesthetics is something we do in our practice every day. I have evolved my approach with lips enhancements because of the particular challenge to have improvement, but at the same time a minimal amount of swelling and downtime, and and in a consistent way.
The perception I have from looking at what looks like multiple islands of filler that are relatively superficially placed,  my conclusion is most likely a hyaluronic acid filler was placed with multiple injections into the lip. Some of that material was released relatively superficially, hence the causes of the bumps.
Generally with lip anatomy, enhancement of the volume of the lip in my experience and approach in doing this is to place the volume mostly deep. Anything that is superficial is limited to areas that are not in that pink area, and more along the lip border called the vermilion border. That said, you’re in a situation where the strategy and approach probably induced some significant swelling, which is why you needed to take time off work.
I think these bumps are probably going to get better from just the massage your injector recommended, but hyaluronic acid fillers at a certain point will  reach a certain equilibrium or balance, and it might persist until the body breaks it down. You have to decide whether you’re comfortable with allowing that certain amount to be present.
Generally, when we do injectable fillers for our patients, whether it’s for the lip or anywhere else, we see patients after two weeks. I can generally predict that whatever I see after two weeks is basically going to be stable for a while, and that for the first week or so, there’s some swelling that can affect the picture.
When I do volume enhancement for lips, I generally use a technique using blunt cannulas. I can significantly improve my outcomes using this approach. I strategically place entry points, then I place the filler in a way that minimizes the trauma,bruising, and swelling. Further, I find I have a lot more control in getting the level of the lips I want enhanced, and avoid some of the more superficial placements. It’s not impossible, and it certainly can happen, but in my experience this technique has been very consistent. When I read something like your situation where you often have to take time off to allow for swelling and other things to resolve, that’s one of the reasons that motivated me to help my patients through evolving the technique. Once someone gets a nice result they like, eventually the filler goes away, and naturally they want to do it again. If they have a not so great experience, they may be hesitant to do it again.
It’s important with any aesthetic procedure that requires maintenance to do everything you can to minimize swelling, bruising, and maximize predictability. It doesn't mean that at the two week visit, sometimes patients want more volume, and they may ask for more volume. That’s fine, and little enhancements are also fine, but I think this is a situation where the material is focused in different little islands. It is possible with a little bit of massage and just natural movement from smiling, talking and moving, you can get resolution.
To address the question about the enzyme hyaluronidase, you may get a little swelling, but since the area is a little small, a small amount of enzyme may go a long way. You may choose in a couple of weeks after it has settled out. If you are still bothered by the appearance, then you can address with the enzyme, and maybe allow for a day or so of swelling related to the procedure. There’s a lot of nuance in the approach and style, the touch, and the fact that lips are sensitive and can swell. Even in the best, most experienced hands, a little swelling is a normal part of the process.
Talk to your injector about this. I think it’s a good idea to document for yourself like with a photo you took to see if a week later, it looks pretty much the same, or two weeks later it looks the same. At that point, the most practical thing may be to dissolve some of this filler, and just let things not look as irregular. It’s difficult to appreciate the three dimensional aspect of your appearance with a two dimensional photo, and that’s where a physical exam is superior to just the photo. I hope that was helpful, I wish you the best of luck and thank you for your question.

Sometimes lumps and bumps are normal in the beginning phases, as swelling resolves.  These usually resolve with time as the swelling goes down, or are massaged by your provider.  I do this routinely for all patients to make sure they look great afterwards, so you should follow up with your provider to address your concerns. Best of luck.

Thanks so much for sharing this concern. I see the problem area, but it seems rather subtle. I believe, therefore, that massaging probably will help. I suggest you follow your injector's instructions and then come back for a follow up in a few weeks to check on your final results.Good luck. Dr. ALDO