Uneven Restylane Lip - Should I Go to a Different Doctor? Should I Dissolve or Add More to One Side? (photo)

I had a restylane lip injection 5 days ago. My lip has been un-even since the injection. After the swelling, my upper lip is still uneven. I am going tomorrow for a follow-up from the same doctor and didn't know if it was a good idea to try to let him fix it or even it up - if someone messes it up once, is it better to go to a different physician? Or would a different doctor have more trouble? IMPORTANT: Is it better to try to reduce one side of the lip or add more restylane to the other side?

Doctor Answers 11

Hyaluronic Acid Fillers Work Well For Lip Augmentation

Nonsurgical lip augmentation with hyaluronic acid fillers has become extremely popular in the past few years. These fillers have been used successfully for defining the vermilion border and white roll areas of the lips, creating or accentuating the Cupid's Bow and Philtral Columns, and restoring body and proper proportions to the red areas of the lips that often shrink with age (or may be a familial trait) and the surrounding dry areas above and below them. I prefer Restylane L, which is known for its lifting capacity, for plumping the tubercles of the lips and for defining the vermilion border (since it stays where it is put and demonstrates little spreading). I prefer Juvederm Ultra XC for the remainder of the red portions of the lip, since it is smoother and spreads more evenly. In general, I combine the use of these agents, rather than depending upon a one filler fits all approach.

"What you see (immediately following injection of filler) is what you get (after all the dust settles)" is a good general rule of thumb that I emphasize to my patients undergoing filler treatments of all kinds, including lips. This means that the improvement they see in the mirror seconds after treatment is pretty much what they can expect to have as their final result after all the bruising, swelling and tissue distortion--which can sometimes be quite asymmetrical--that may occur in the ensuing minutes, hours and even a couple of weeks or more following the treatment. In other words, if the result is uneven seconds after injection, it should be dealt with then. Otherwise, it will probably need to be dealt with a few weeks later when all the post-treatment swelling has subsided. This may constitute adding more material if necessary or removing excess material with hyaluronidase if needed. Treating lips demands experienced medical hands and a practiced aesthetic eye to ensure proper sculpting and fashioning of the treatment areas in order to achieve symmetry and proportion.

New York Dermatologic Surgeon
4.9 out of 5 stars 32 reviews

Uneven result after Restylane

The lips may have swollen assymetrically or you could have had an asymmetry to begin with which wasn't addressed by the injector.  The simplest way to correct this is generally to inject more product on the smaller side.  However, I would encourage you to wait at least another week before having a followup procedure.  Definitely see your doctor tomorrow and discuss your concerns.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Uneven lips after Restylane will usually even itself out after about a week.

Sometimes after lips are injected with filler, they appear uneven.  This is possible for a number of reasons.  First, they weren't even to start with. Second, there is assymetric swelling or bruising.  Third, there was an uneven amount of Restylane or Juvederm placed.  The best thing is to wait about a week before doing any modifications.  Sometimes adding a little to the less filled side will be sufficient.  Sometimes you need to dissolve a lump with hyaluronidase.  But, most of the time, nothing needs to be done, and it all looks OK after a week.  It's important to have the doctor take good before pictures so that pre-existing assymeties can be evaluated.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Concerns after filler injection in lips

It is not uncommon to have swelling after filler injection in the lips but if there is signficant asymmetry several days later I recommend follow up with your injector.  At times there is just asymmetric swelling but in other situations the product needs to be manipulated, massaged, or even removed.  I have seen some patients go for months unhappy with their appearance, assuming there is nothing that can be done to correct asymmetry.  This is not the case when hyaluronic acids such as Restylane, Juvederm, or Belotero have been used.  Products such as Radiesse, Sculptra, and Artefill should not be injected in the lips as they are not easily modified or removed.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

Injections to lips and asymmetry

Everyone has asymmetry to begin with.  If filler was injected evenly then the asymmetry would be present. Also you may have differential swelling. It is probably best to give it a few weeks to settle. If still not right you may need a bit more filler.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Uneven Restylane Lip - Should I Go to a Different Doctor? Should I Dissolve or Add More to One Side?

I suggest you wait 2-3 weeks for the swelling to settle before you consider applying more filler or hyaluronidase

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Restylane and swelling in the lips

Sounds like your approach of follow up is a good idea - however it can take up to two weeks sometimes, for the swelling to subside. Depending on the look you are trying to achieve, removing product or adding to is going to give you either a more augmented look or more natural.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Lips injected with Restylane can sometimes swell for up to two weeks

It is best to wait up to two weeks before you decide to remove the filler.  Sometimes swelling from the injection itself can interfere and make you seem uneven.  Good luck and let me know what happens.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Wait 2 weeks after Restylane to decide on further treatment.

You should wait for 2 weeks after your injections to see the full result.  It is possible that you have a bruise that is causing the unevenness.  If still uneven, return to the same injector to discuss whether you should have a bit removed from one side or a little added to the other.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

Uneven Restylane Lip - Should I Go to a Different Doctor? Should I Dissolve or Add More to One Side?

Thanks for the questions and very detailed posted photos. But it appears you do research so you must understand the swelling COULD TAKE 2 weeks to subside! Thus WAIT, use ice compresses, massages before considering more filler or or invasive treatments! 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.