Why do I have these lumps and is it fixable? (Photo)
Doctor Answers 4
Lumps after lip augmentation
Common side effects such as bruising, swelling, redness and pain, are most typical of the injection procedure itself rather than the product used. The use of medications prior to injection that predispose to bleeding, such as aspirin, NSAIDs, fish oil, Ginko and/or vitamin E, can increase the risk further. Fortunately, these complications are more irritating than serious, and can be easily managed with cool compresses, camouflage makeup and/or laser treatments (pulsed dye, Excel V).
Rare complications are more frequently due to poor technique, lack of experience, or just frank bad luck. Symptoms you should be concerned with after injectable filler treatment are reports of significant pain or change in skin color beyond the typical pain and redness or bruising from injection. These symptoms have serious implications and should be evaluated immediately if reported after treatment.
Choosing the Right Filler
Choosing the Right Filler
The lip is unique in its anatomy. Treatment in this area is less forgiving than other areas of the face primarily due to the increased vasculature, complexity in shape and dimension, wet and dry borders, as well as frequent, active nearby muscular movements. Pristine technique and proper filler selection is needed to limit complications and give optimal aesthetic improvements. The rheological principals of the filler chosen are much more or less likely to cause acute complications such as nodules or swelling as seen in the presented case. For example:
- Voluma has a much higher G prime then other forms of Juvederm and has the capacity to “lift” the lips more than others, potentiating the ability to form nodules, pain and swelling.
- Particulate fillers such as Restylane can give more structure to the lip, but may compromise the softness seen with other homogenous hyaluronic acid fillers such as Juvederm or Belotero.
- The hydrophilic nature of hyaluronic acid fillers requires the practitioner to avoid over treatment in order to prevent prolonged swelling and unpredictable results leading to patient unhappiness.
- Semi-permanent fillers such as Radiesse, Artefill and/or Sculptra (biostimulant) should not be injected into this area, as the muscular movement can cause clumping of filler product and potentiate nodule formation, leading to permanent irregularity requiring surgical removal.
Techniques for Success
Since swelling is immediate in areas of increased vascularity and can cause the local anatomy to quickly alter, optimal aesthetic results of the lip are more difficult to attain if the procedure is not performed swiftly and precisely. Therefore, I teach a “10-second” rule, where choosing your injection site, performing the injection and deciding if you need to make edits, takes a total of, at most, 10 seconds. Microcannulas limit the amount of swelling and bruising by being blunt rather than sharp, and being more flexible than rigid, compared to needles. Through only a few access points, microcannulas can be used contour and lift an area that would otherwise need a number of serial puncture injections or threads. The lack of tissue trauma by the blunt nature of the product makes treatments virtually pain free and bloodless. My only caveat is that the ability to “fine-tune” the lip shape, create eversion and/or define the vermillion or lip corners is more restricted/difficult with cannulas compared with a sharp needle. Finally, it is important not to forget:
- Treatment around the lip/mouth into the vermillion can improve lip lines and give eversion and lift.
- Treatment of the upper cutaneous lip and pyriform aperture, as well as the lower cutaneous lip and chin fat pads, can give the lip/mouth support that often decreases with age due to fat atrophy and bony resorption beneath.
- To always check the inside of the mouth for good dentition, as lack of teeth or periodontal disease can be a cause for lack of lip/mouth shape, contour and support.