Long term redness above upper lip border (Photo)

Question

I've been getting lip filler for over 10 years. No issues. There is redness above my upper lip that blurs my lip borders now and it makes my lip look odd without makeup. One of the things I loved about filler in the past was I could go without lipstick. Not anymore. It's been like this for about 1.5 years. No pain or irritation. Has anyone seen a patient with this before and is it treatable?

James M. Economides, MD, FACS · Answer

It sounds frustrating to experience changes after many years of successful treatments. The redness and blurred lip borders you're describing could be related to a few different factors, but the good news is that it's likely treatable. Here are some possibilities and treatment options:

1. Filler Migration:
Over time, filler can migrate slightly beyond the lip borders, creating a blurred or puffy appearance. Even if you don't feel lumps, the product may have subtly shifted over time.
Treatment: A mild amount of hyaluronidase can dissolve the migrated filler while leaving the rest intact, allowing your injector to refine the lip border.
2. Skin Thinning or Sensitivity:
After many years of treatments, the skin around the lips may have thinned slightly, causing more noticeable changes in texture or color. This can lead to a blurring of the lip line.
Treatment: A combination of light skin resurfacing (like laser or microneedling) or specific topical treatments to strengthen the skin barrier and reduce redness could help. If needed, a small amount of filler can also be placed along the vermilion border to better define the lips again.
3. Vascular Changes:
Long-term filler use could cause subtle vascular changes around the lips, contributing to redness. Though not harmful, this could be cosmetically bothersome.
Treatment: Light laser treatments (such as IPL or vascular lasers) can reduce the redness above your lips by targeting any visible blood vessels or capillaries.
4. Post-Inflammatory Hyperpigmentation or Irritation:
Although you don't have irritation or pain, there could be mild, subclinical inflammation leading to redness and discoloration.
Treatment: Topical treatments with anti-inflammatory ingredients like niacinamide, peptides, or calming agents could help. Your dermatologist might also suggest a mild steroid cream for short-term use to reduce inflammation.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. This is certainly an interesting finding. This looks more like a topical reaction to something rather than something resulting from fillers. I would look at any and all products you are placing on your lips throughout the day and see if there is anything that might be causing this. Further evaluation and treatment by a dermatologist might help as well. If you go through all of that and get no answers or results, you can always consider going through the process of dissolving any remaining filler in the area. We know that although we tell patients that HA fillers last a year or so, it is more likely that some portions of the product remain around and can migrate over time. In addition, if you have had other non-HA fillers in the lips, those products might not be able to be dissolved. 
Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Mats Hagstrom, MD (license on probation) · Answer

If you have not done so already, I would highly recommend seeing a dermatologist. And this redness is probably not related to your fillers, but regardless, you need to get an understanding of the ideology and potential treatment options.
If a dermatologist can’t make a definitive diagnosis, then consider having a few second opinions, or if there’s an academic medical center where you consider consulting at a higher level of care, or look for senior dermatologist with a lot of experience.
Best,
Mats Hagstrom, MD

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