What can I do to fix this bulbous spot in my cheek? (Photo)

Question

Can someone please help me! I’ve been to a plastic surgeon with an ultra sound and he said he couldn’t see anymore product or there wasn’t “much there” I want to get them dissolved but he says it’s just swelling. It’s been two years and the distortion of my cheek has really hurt me psychologically. It’s bulbous in a spot that it shouldn’t be. What can I do to fix this. Please someone give me some advice. Thank you.

Anna Chacon, MD, FAAD · Answer

If there is no remaining filler detectable on ultrasound, the fullness may be due to residual swelling, scar tissue, fat redistribution, or changes in the soft tissue after the original treatment. Management options can include corticosteroid injections for scar tissue, radiofrequency or ultrasound-based skin tightening to improve contour, or surgical revision if there is significant localized tissue change. A thorough in-person evaluation is essential to differentiate between residual filler, fibrotic tissue, or natural anatomical variation, as treatment will vary depending on the underlying cause.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. The first step is to try to dissolve the bumps with Vitrase. If that does not work then consider drawing or excising the bumps with an experienced oculofacial surgeon. 
Good luck!

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It sounds like you’re dealing with a challenging situation that has significantly impacted your self-esteem. Given that your plastic surgeon couldn't identify remaining filler through ultrasound and suggested that the issue might be related to swelling, but you're still experiencing noticeable distortion, there are several treatment options to consider. First, if the ultrasound didn’t reveal much, other diagnostic methods could be explored. Advanced imaging techniques, such as MRI or high-resolution CT scans, might offer more detailed information about the nature of the distortion and help determine if there’s residual filler or other contributing factors. Second, if the issue is primarily swelling or if residual filler is still suspected, treatments like corticosteroid injections might help reduce inflammation and swelling. This can sometimes address residual swelling that might not be visible through ultrasound. Third, in cases where non-invasive approaches have not yielded results, a surgical approach might be necessary. For persistent distortion, a surgical procedure to correct the contour or remove the residual product might be warranted. I hope this helps and best of luck!

Kenneth D. Steinsapir, MD · Answer

People who rely on ultrasound to confirm the presence fillers are telling you they don’t understand your face and have no real insight about how the filler is affecting your appearance. Little secret: you don’t need ultrasound to understand where the filler is sitting. I remove a lot of fillers from the face and while the ultrasound is academically interesting it is ignorant to think an ultrasound is needed to know where to inject enzyme.

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